E-Cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations

  • Aruni BhatnagarEmail author
Cardiovascular Risk Health Policy (W. Rosamond, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Risk Health Policy


Cardiovascular disease is the major cause of death in smokers. Although new tobacco products such as e-cigarettes do not generate many of the harmful or potentially harmful constituents (HPHCs), present in combustible tobacco products the cardiovascular effects of these devices are unknown and their efficacy in promoting and sustaining cessation remains unclear. Currently, these devices are being marketed as cleaner and safer alternative to smoking that could help smokers quit smoking. Nevertheless, e-cigarette aerosols contain appreciable levels of carbonyls, which within the concentration range reported in e-cigarettes, exert significant cardiovascular toxicity. Moreover, even by itself, nicotine is a sympathomimetic drug that elicits hemodynamic and metabolic changes that could increase the risk of acute cardiovascular events such as arrhythmias or plaque rupture and chronically increase cardiovascular disease risk by inducing dyslipidemia. The dose-response relationship between smoking and cardiovascular mortality is non-linear, suggesting that reduction in HPHC concentrations in e-cigarette aerosols may not result in proportional harm reduction and decreased HPHC exposure may be offset by increased use by individuals who believe that e-cigarettes are safer than conventional cigarettes. Thus, taken together, current evidence does not entirely support the notion that e-cigarettes are reduced harm products or effective smoking cessation devices.


Smoking Acrolein Particulate matter Formaldehyde Acetaldehyde Blood pressure Atherosclerosis 



This work was supported in part by the NIH grant HL120163 to the American Heart Association; however, the view presented does not reflect the policy of the American Heart Association or the Food and Drug Administration.

Compliance with Ethical Standards

Conflict of Interest

Dr. Bhatnagar declares no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.American Heart Association Tobacco Regulation and Addiction Center, Division of Cardiovacular Medicine, Department of MedicineUniversity of LouisvilleLouisvilleUSA

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