Quit Smoking, Started Vaping? Your Heart Attack Risk May Rise, Says ICMR Study

A comprehensive new study led by the Indian Council of Medical Research-National Institute of Cancer Prevention and Research (ICMR-NICPR) has delivered a clear warning: Electronic cigarettes (e-cigarettes) are not safe alternatives to conventional tobacco smoking. Using large-scale data from 12 global studies involving more than 1.2 million participants, researchers found that e-cigarette users face a significantly increased risk of heart attacks, up to 53% higher than non-users, and that the danger persists even after accounting for traditional cigarette smoking. Former smokers who switched to e-cigarettes experienced more than double the risk of heart attack compared with those who quit all tobacco and nicotine products.

This finding challenges a widespread belief that vaping is a benign way to quit smoking. While e-cigarettes may produce vapour instead of smoke, they still deliver nicotine, a substance known to affect heart rate, blood pressure, and vascular health. Health experts indicate that nicotine itself can trigger a cascade of cardiovascular damage regardless of delivery method. As the debate over tobacco harm reduction continues worldwide, this large meta-analysis underscores the urgent need for smokers to pursue effective and evidence-based cessation strategies, and not to substitute one nicotine product for another.

Key Findings Of The ICMR Meta-Analysis

The ICMR-led review, published in BMC Public Health, systematically analysed 12 observational studies encompassing over 1.2 million individuals. The researchers extracted 26 estimates, including 11 for myocardial infarction (heart attack) and 15 for stroke. Their results revealed:

• E-cigarette users had 1.53 times higher odds of having a heart attack compared with non-users.
• Even after adjusting for conventional cigarette use, e-cigarette users showed a 1.24 times increased heart attack risk.
• Former smokers who switched to e-cigarettes faced 2.52 times higher heart attack risk compared with those who fully quit tobacco and nicotine products.
• Stroke risk exhibited similar patterns among e-cigarette users.

These findings dispel the myth that e-cigarettes are harmless alternatives to smoking. Despite lacking combustion products like tar and carbon monoxide, e-cigarettes still deliver nicotine and other toxic compounds that negatively impact cardiovascular health.

Why Nicotine And E-Cigarettes Harm The Heart

Nicotine is a potent cardiovascular stimulant. According to the World Heart Federation, nicotine increases heart rate and blood pressure and can impair blood vessel function, all factors that raise the risk of cardiovascular disease, including heart attacks and stroke. 

Moreover, National Heart, Lung, and Blood Institute (NHLBI)-supported research demonstrates that e-cigarette use can damage blood vessels, reduce nitric oxide production (critical for healthy vascular function), and increase cellular permeability, contributing to cardiovascular dysfunction similar to smoking. 

Prospective research presented by the American College of Cardiology found that e-cigarette users had an elevated risk of developing heart failure - independent of traditional smoking and other risk factors - further indicating that vaping is not free of serious heart risks. 

Comparisons With Traditional Smoking And Dual Use

While it's widely understood that traditional cigarettes contain thousands of harmful chemicals that contribute to heart and lung disease, scientific evidence increasingly shows that e-cigarettes are not benign. A meta-analysis in the European Journal of Preventive Cardiology concluded that e-cigarettes should not be considered safe for cardiovascular health, noting mechanisms like thrombosis and atherosclerosis may still be elevated in users. 

Additionally, research by the American Heart Association found that adults who used both cigarettes and e-cigarettes did not experience cardiovascular benefits compared with exclusive smokers, reinforcing that dual use offers no protective effect.

Implications For Public Health And Policy

The ICMR study's authors emphasised that their findings validate India's 2019 decision to ban e-cigarettes, a policy aimed at curbing nicotine addiction and protecting public health. They argue that marketing e-cigarettes as cessation tools creates a "harm-reduction trap," where smokers repeatedly switch but remain addicted to nicotine and at elevated cardiovascular risk.

Health experts recommend that smokers seeking to quit should prioritise proven, evidence-based cessation methods, such as behavioural counselling and FDA-approved pharmacotherapies, rather than turning to e-cigarettes. Comprehensive cessation services remain a critical component of reducing tobacco-related disease burdens.

The recent ICMR-NICPR meta-analysis adds powerful evidence to a growing scientific consensus: e-cigarettes are not a heart-safe alternative to traditional smoking. With significantly raised risks of heart attack, stroke, and other cardiovascular harms, particularly among smokers who switch to vaping, the safest choice remains quitting all nicotine products. Health authorities worldwide urge a shift towards verified cessation strategies backed by clinical evidence over unproven nicotine substitutes.

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