Vaping Associated With Worsening of Pulmonary and Cardiovascular Health

Those who chronically vaped had acute worsening of blood pressure and heart rate, vasoconstriction, lower exercise tolerance, and increased airflow obstruction.

Individuals who vape develop acute, clinically related worsening of multiple pulmonary and cardiovascular processes, according to study findings published in CHEST.

Recent research shows more than 20% of high school-aged adolescents and even more young adults self-report vaping, which is currently done with electronic nicotine delivery systems (ENDS) that achieve higher temperatures and greater nicotine delivery than achieved previously. Researchers sought to compare cardiovascular and pulmonary responses to an acute 15-minute ENDS/combustible cigarettes product-use challenge among individuals who regularly use nicotine-containing products vs individuals who had previously neither smoked nor vaped.

The researchers conducted an observational pre/post challenge study of nicotine-containing products (CLUES; Identifier: NCT03863509) that included 395 community-dwelling participants at least 18 years of age recruited from metropolitan Madison, Wisconsin, who had a stable pattern of product use for at least the past 6 months and were not using smoking cessation medication. The cohort included sole users of combustible cigarettes (positive urine nicotine; exhaled carbon monoxide [CO] >5ppm; n=117), sole users of ENDS (positive urine nicotine; CO<5ppm; n=164), and controls (nonsmoking/nonvaping; negative urine nicotine; CO<5ppm; n=114).

Researchers found between-group differences by age, sex, race, and product use between those who used cigarettes (mean age, 42.8 years; 44.4% women; 65% White; mean smoking duration, 21 years), ENDS (mean age, 27.4 years; 39.0% women; 86.0% White; mean vaping duration, 4.0 years), and control group participants (mean age, 30.8 years; 50.0% women; 69.3% White; 0.0 years smoking or vaping).

One episode of ENDS use is associated with the acute worsening of cardiovascular and pulmonary health indices among chronic ENDS users.

Only those who used cigarettes registered exhaled CO levels (median 18.0ppm; interquartile range [IQR], 17.0); those using ENDS and participants in the control group did not register exhaled CO levels (0.0ppm; IQR, 1.0). After adjusting for age, sex, and race/ethnicity, autonomic and cardiovascular function responses were similar between groups prior to product exposure except for heart rate variability, heart rate, and aortic augmentation index (all significantly worse among those using cigarettes vs those using ENDS or those in the control group).

Researchers noted that individuals using cigarettes puffed a median 14.0 times (IQR, 9.3), and individuals using ENDS puffed a median 9.0 times (IQR, 7.5) (P <.001) during the 15-minute product challenge.

Users of ENDS vs those in the control group had greater increases in adjusted mean differences (AMDs) in heart rate (4.8; 95% CI, 4.0-5.6 vs -1.3; 95% CI, -2.2 to -0.3; P <.001), diastolic blood pressure (4.2 mmHg; 95% CI, 3.3-5.0 vs 2.0; 95% CI, 1.1-3.0; P =.003), systolic blood pressure (5.6 mmHg; 95% CI, 4.4-6.8 vs 2.3; 95% CI, 0.8-3.8; P =.001), and greater reductions in forced expiratory volume in 1 second (-4.1; 95% CI, -5.4 to -2.8 vs -1.1; 95% CI, -2.7 to 0.6; P =.005), time-domain heart rate variability (-7.2; 95% CI, -10.5 to -3.7 vs 3.6; 95% CI, 1.6-9.3; P =.001), and brachial artery diameter (-0.011; 95% CI, -0.013 to 0.009 vs -0.006; 95% CI, -0.004 to -0.009; P =.003), all with values similar to those using cigarettes.

Those using ENDS performed worse than those in the control group on 60-second heart rate recovery (AMD, 2.9 beats/minute; 95% CI, 0.7-5.0; P =.008) and metabolic equivalents (ME) (AMD, 1.28ME; 95% CI, 0.73-1.83; P <.001).

Study limitations include the observational design, which does not provide proof of causal effects of ENDS use, and significant differences among cohorts with respect to age, race/ethnicity, and length of product use.

“[Those using ENDS] had acute worsening of blood pressure, heart rate, and heart rate variability, as well as vasoconstriction, impaired exercise tolerance, and increased airflow obstruction after vaping, compared to controls,” the study authors concluded. “One episode of ENDS use is associated with the acute worsening of cardiovascular and pulmonary health indices among chronic ENDS users,” the researchers noted.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Tattersall MC, Hughey CM, Piasecki TM, et al. Cardiovascular and pulmonary responses to acute use of electronic nicotine delivery systems and combustible cigarettes in chronic users. Chest. Published online April 10, 2023. doi:10.1016/j.chest.2023.03.047