E-Cigarette Use and Heart Attack Risk in Former Smokers

Key Takeaways for Clinicians and Nurses

A new large-scale meta-analysis published in BMC Public Health reports that e-cigarette use is associated with a significantly higher risk of myocardial infarction (MI), particularly among former cigarette smokers. While exclusive vaping among never-smokers showed no statistically significant cardiovascular risk, the findings raise important concerns about positioning e-cigarettes as harm-reduction tools in clinical practice.

Reassessing the Cardiovascular Safety of E-Cigarettes

Electronic cigarettes have been widely marketed as safer alternatives to combustible tobacco, especially for smoking cessation. However, growing evidence suggests that vaping may not be cardiovascularly neutral. This comprehensive systematic review and meta-analysis evaluated whether e-cigarette use independently increases the risk of myocardial infarction and stroke, while carefully accounting for conventional smoking history.

What the Evidence Shows

Researchers analyzed data from 12 observational studies, including over 430,000 participants for myocardial infarction outcomes and more than 1.1 million individuals for stroke analyses. Studies with tobacco industry funding were excluded to reduce bias, and random-effects models were used to calculate adjusted odds ratios.

Key findings include:

• E-cigarette users had 53% higher odds of myocardial infarction compared with non-users.
• After adjusting for cigarette smoking, MI risk remained elevated (24% higher odds).
• Former smokers who currently vape had more than double the risk of heart attack compared with non-users.
• Stroke risk was not significantly increased overall, but former smokers using e-cigarettes showed a 73% higher stroke risk.

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Among exclusive e-cigarette users who never smoked, no statistically significant association was found for MI or stroke. However, authors caution that limited data and potential misclassification may influence these estimates.

Clinical and Public Health Implications of E-Cigarette Use and Risks

From a cardiovascular perspective, these findings highlight that prior smoking history remains a critical modifier of risk. The elevated MI and stroke risk observed among former smokers who vape may reflect cumulative vascular injury, persistent inflammation, or residual confounding rather than vaping alone. Nonetheless, the assumption that e-cigarettes are a low-risk transition strategy warrants careful reconsideration.

For clinicians counselling patients on smoking cessation, the data reinforce the need for evidence-based alternatives and transparent discussions around cardiovascular risk, especially for patients with existing risk factors.

What This Means for Practice

While longitudinal studies are still needed, current evidence suggests that e-cigarettes should not be considered harmless, particularly for former smokers. Healthcare professionals should remain cautious when recommending vaping as a harm-reduction approach and continue prioritizing established cessation therapies with proven cardiovascular safety profiles.

Source:

Springer Nature