Vaping: A Heart Health Emergency

By: Dr. D.P. Suresh, Executive Medical Director
Florence Wormald Heart & Vascular Institute at St. Elizabeth

Vaping was once touted as a safer alternative to smoking. Today, however, after several years of clinical study and treating patients with EVALI (E-cigarette or Vaping Use-Associated Injury), we know vaping is a public health emergency.

The negative effects of vaping on the lungs are well known, but the less-discussed cardiovascular risks are equally as significant. People who vape are 56% more likely to have a heart attack and 34% more likely to experience a stroke. Vaping also increases the risk of coronary artery disease and blood clots, raises the heart rate, causes an irregular heartbeat, and leads to a buildup of plaque in the arteries.

As physicians, we can potentially reduce those adverse events by discussing the dangers with our adult patients and partnering with pediatricians to educate teens, as well.

According to the most recent statistics, 8.1 million Americans use some type of vaping device. What’s particularly concerning is that teens — more than 2 million high schoolers and nearly 500,000 middle schoolers — make up roughly 25% of this group. As of 2020, 20% of high school students vaped, and their risk of becoming cigarette smokers is seven times higher than youth who never vape.

Unless vaping levels drop, we will soon see a generation of patients with an early onset of substantial cardiovascular problems. The Food & Drug Administration’s initial marketing ban of JUUL devices (although that decision is now on hold pending further scientific investigation) is a step in the right direction but informing our patients about how vaping affects them is the best protection we can offer.

When discussing vaping with your patients, these four points are important to discuss:

• The vapor immediately enters the bloodstream. Unlike cigarette smoke, which is absorbed by the lungs and metabolized through the liver, vapor from e-cigarettes directly enters the bloodstream. This vapor almost always contains nicotine, which decreases circulation, hardens arteries, and reduces blood-oxygen levels.
• E-liquids destroy the lining of the blood vessels. The endothelial cells that line the inside of the blood vessels die when they encounter the e-liquids used in vaping devices. Once exposed, the cells die and are no longer able to form new vascular tubes.
• The chemicals in vaping devices haven’t been studied. The ingredients used to make cigarettes have been studied for decades. As a result, we know the long-term effects on the body. However, we don’t have the same research on substances used in vaping devices. While we don’t yet know all the ways vaping affects the body, we do know it puts people — particularly young women — at risk for early heart attacks and strokes.
• Second-hand vaping can happen without someone recognizing it. Research shows that exposure to second-hand vapor has the same impact as breathing in second-hand smoke, including the increased cardiovascular risks. However, because many vaping devices are smokeless, it can be much harder to know if someone is breathing in e-cigarette vapor.