Whether vaping is bad for your heart is unclear, but it's probable. Ever since E-cigarettes became available about 15 years ago, there have been more questions than answers. What we do know is that smoking and its associated exposure to nicotine and other toxins is deadly but preventable.

Key takeaways:
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    E-cigarette use carries risks to the heart and cardiovascular system.
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    Vaping may be safer than tobacco use, but the consequences are still unknown and may be just as harmful.
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    Youth and young adults should avoid vaping.
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    Risks may include elevated or depressed heart rate, elevated blood pressure, cardiac arrhythmias, and more.

The idea behind E-cigarettes was to maintain a profit, alter the market conditions, and promote different health messages.

Despite the promise of E-cigarettes offering lowered smoke levels and fewer carcinogens, there is still not enough research to be able to draw a conclusion as to whether E-cigarettes are safer than conventional tobacco cigarettes.

A recently published pre-clinical study demonstrated risks, particularly to the heart and cardiovascular system.

How do most healthcare professionals view vaping?

As a general rule, most healthcare professionals are against vaping. In particular, they recommend that no nicotine products should be used by young people. For a long time now, there has been a concerted effort by healthcare professionals to fully educate all adults regarding nicotine and tobacco use.

While it may be that non-combustible products may carry fewer risks, the only way to get people to stop using nicotine an addictive substance, and other potentially dangerous chemicals is to have people stop using all related products. E-cigarettes may pose other risks, including exposure to other chemicals not found in tobacco cigarettes.

The main focus should be on breaking the addiction cycle when addressing tobacco smoking or vaping. We do know that quitting tobacco smoking improves blood pressure control and heart health, as well as improved breathing. This is the conclusion made by most healthcare professionals despite some indications globally that the use of E-cigarettes may reduce the use of tobacco and act as an alternative.

Vaping appears to be a dynamic trend. Some E-cigarettes have been associated with the illicit sale of contaminated tetrahydrocannabinol (THC) products. Healthcare professionals must be vigilant in keeping themselves updated on not just the risks of vaping, but the use and misuse, and current regulations.

What are the risks of vaping?

Vaping has become increasingly popular. The risks may be variable since some E-cigarettes deliver nicotine and some do not. Instead, some vaping products have flavoring, while others deliver psychoactive substances, such as THC (the primary psychoactive compound in marijuana) or cannabidiol (CBD).

Risk in using E-cigarettes was defined by the US National Academy of Sciences as: “Overall, E-cigarette aerosol contains fewer numbers and lower levels of toxicants than smoke from combustible tobacco cigarettes.”

The definition also said, “Overall, the evidence reviewed by the committee suggests that E-cigarettes are not without biological effects in humans.”

What are the biological effects?

The debate continues as to what the biologic effects of vaping are on humans. It is possible that these products may play a role in helping people stop using combustible tobacco products so it is important to know what potential harm they may impose.

If vaping is just as dangerous or more so, then trading combustible tobacco products for E-cigarettes makes little sense. Both may equally induce lung and heart disease.

One further hurdle in using E-cigarettes is that you may not know the contents of the product. Some manufacturers claim that E-cigarettes do not create the same toxins as combustible tobacco products, but some studies show that vaping allows for the inhalation of highly heated chemicals, specifically propylene glycol, and that irritates both the cardiovascular and respiratory systems, imposing undue health hazards.

What are the effects on the heart and cardiovascular system?

Overall, E-cigarettes acutely and negatively affect heart rate (increased) and are associated with elevated blood pressure readings (both systolic and diastolic). It is possible that the effects are less than combustible tobacco products, but still there may be bad consequences.

There are reports that E-cigarettes may contribute to endothelial cell dysfunction and oxidative stress, which may lead to atherosclerosis. In addition, E-cigarettes may also affect platelet function and therefore increase the chances of blood clots or thrombosis.

The most recent pre-clinical study suggests that E-cigarettes induce cardiac arrhythmia and conduction defects in mice. The culprit appears to be the aerosols from E-cigarette solvents, namely vegetable glycerin, and propylene glycol. The results led to bradycardia (slow heart rate), bradyarrhythmia (slow irregular heart rate), and elevations in heart rate variability. The conclusion was that the chemical constituents of E-cigarettes led to increased cardiac risk by causing cardiac arrhythmias and stimulating autonomic reflexes.

Some conflicting studies may indicate that exposure to E-cigarettes does not pose any underlying cardiac or cardiovascular risk. However, these studies may be misleading since they looked more at E-cigarette usage patterns and users' experiences. Since the studies had so many variables in sample size and how the E-cigarettes were used, the results may be difficult to make any meaningful conclusions.

The US Federal Drug Administration is still in the process of evaluating E-cigarette use, but meaningful regulation is still lacking.

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