A COMPREHENSIVE systematic review and meta-analysis has found that e-cigarette use may increase the risk of myocardial infarction (MI) and stroke.
E-Cigarette Use and Cardiovascular Risk Under Review
The analysis was conducted between January 2005 through June 2025, including 12 observational studies and randomised trials comprising over 1.5 million participants. The study yielded 26 estimates in total: 11 estimates for myocardial infarction (67,253 e-cigarette users and 363,622 non-users) and 15 estimates for stroke (121,113 e-cigarette users and 1,064,228 non-users). Researchers examined the associations between e-cigarette use and cardiovascular events while adjusting for confounding factors, including prior cigarette smoking. This research addresses the ongoing debate regarding the cardiovascular safety of e-cigarettes, which are widely promoted as a safer alternative to traditional tobacco.
Increased Risk Found for Heart Attack and Stroke
Quantitative synthesis revealed that e-cigarette users had a 1.53-fold higher risk of MI compared to non-users, with a meta-odds ratio (meta-OR) of 1.24 after adjusting for cigarette smoking. Notably, the risk was higher among current e-cigarette users who were former cigarette smokers, showing a 2.52-fold increase in risk of MI. Stroke risk was slightly elevated among e-cigarette users overall (meta-OR: 1.05), but former smokers using e-cigarettes had a 1.73-fold increased risk of stroke compared to non-users. These findings suggest that e-cigarette use, particularly among former smokers, may not be harmless for cardiovascular health.
Implications for Public Health and Future Research
The study emphasises the need for well-designed longitudinal research to better define the cardiovascular effects of e-cigarette use and guide evidence-based policy. Clinicians are advised to counsel patients on the potential risks of e-cigarettes, especially for those with a history of conventional cigarette use. While e-cigarettes remain a popular smoking alternative, these findings highlight that they may carry significant heart and vascular risks, warranting caution among users and healthcare providers alike.
Reference
Gupta R et al. Are electronic cigarettes associated with the risk of myocardial infarction and stroke? A systematic review and meta-analysis. BMC Public Health. 2025; DOI:10.1186/s12889-025-25161-2.
