Vaping and Heart Failure: A Narrative Review

Abstract

Electronic cigarette (e-cigarette, or vaping) use has risen dramatically in recent years, particularly among youth and young adults, despite growing concerns regarding its cardiovascular effects. Heart failure (HF) represents a significant public health burden affecting approximately 6.2 million adults in the United States. This review synthesizes the emerging evidence on the association between vaping and HF incidence and outcomes. Preliminary data from the "All of Us" Research Program suggests a possible association between e-cigarette use and increased risk of developing HF with preserved ejection fraction, even after accounting for traditional risk factors. In contrast, the Population Assessment of Tobacco and Health Study (2013-2019) did not find a significant association between exclusive e-cigarette use and cardiovascular events. Multiple biological mechanisms potentially link vaping to HF, including nicotine-induced autonomic dysregulation, oxidative stress, inflammation, endothelial dysfunction, and myocardial fibrosis. E-cigarette use may also worsen HF symptoms, reduce quality of life, and increase hospitalizations. However, current research has significant limitations, including a paucity of long-term prospective studies, challenges in exposure assessment, and potential confounding. Healthcare providers should routinely screen HF patients for e-cigarette use and counsel them about potential risks from conventional cigarette use. Future research priorities include longitudinal studies with standardized exposure assessments, mechanistic investigations, and randomized trials evaluating vaping cessation interventions. Although e-cigarettes may have a role in harm reduction for smokers, a precautionary approach to e-cigarette use is warranted, particularly among individuals with or at risk of HF.

Keywords: heart failure; nicotine products; public health.