Antonio Morales Montalvo, BS
Angélica M. Rosado-Quiñones, PhD

Universidad Central del Caribe, Bayamón, Puerto Rico
Fundación Dr. García Rinaldi, San Juan, Puerto Rico

Introduction

Commercial tobacco product use remains one of the most significant risk factors for cardiovascular diseases. Tobacco companies have marketed electronic commercial tobacco products, such as e-cigarettes and vaping devices, as “safer” alternatives to conventional smoking and a tool for cessation; however, these products still pose health risks. While the increasing popularity of e-cigarettes has contributed to a decline in conventional cigarette use among adults, it has also led to an alarming increase in use among adolescents who were previously non-smokers. This has raised significant concerns about youth-targeted marketing strategies, their impact on youth health, and the need for policy revisions to limit public acceptance of these widespread products. This review describes the experimental and clinical evidence of the cardiovascular effects of e-cigarette use among transitional-age youth (ages 16–24; TAY) since this population uses higher levels of substances than any other age group in the United States.

Methods

A systematic review was conducted on 78 research articles focused on the cardiovascular health effects of e-cigarette toxicity (2011–2024). These effects are influenced by several factors, including e-liquid components such as nicotine, metals, and flavorings.

Results

E-cigarette use negatively impacts endothelial function, consequently increasing arterial stiffness, heart rate, and blood pressure. Flavorings in e-cigarettes have been shown to increase the risk of cardiovascular disease, with some chemicals inducing cytotoxicity. For dual users (conventional cigarette and e-cigarette users), switching to e-cigarettes may slightly improve blood pressure, but the safest approach remains complete cessation. Most studies suggest that in the short term, e-cigarette users had poorer cardiovascular outcomes than non-smokers but fared slightly better outcomes than cigarette smokers, primarily due to lower odds of myocardial infarction.

Conclusion

While acute cardiovascular effects are well documented, further longitudinal and community-based studies are needed to assess long-term impacts and inform public health policies, particularly regarding youth exposure.