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New research links vaping to a higher risk of heart failure. Francesco Carta fotografo/Getty Images
  • More than 64 million people around the world are affected by heart failure.
  • Heart failure can occur if the heart muscle is damaged in some way, such as through disease, high blood pressure, or cigarette smoking.
  • A new study from researchers at MedStar Health says people who use e-cigarettes have a much higher risk of developing heart failure compared to those who have never vaped.

More than 64 million people globally are affected by heart failure — a cardiovascular condition where the heart muscle is not able to pump enough blood for the body.

Heart failure can occur if the heart muscle is damaged by infection, illegal drug use, high blood pressure, a congenital heart defect, heart attack, irregular heart rhythm, certain diseases including diabetes and coronary artery disease, and cigarette smoking.

Now, a new study presented at the American College of Cardiology annual scientific session earlier this month reports that people who use e-cigarettes have a much higher risk of developing heart failure compared to those who have never vaped.

The results of this study have yet to be published in a peer-reviewed scientific journal.

According to Yakubu Bene-Alhasan, MD, MPH, a resident physician at MedStar Health in Baltimore and lead author of this study, although some studies have been conducted on the association between vaping and cardiovascular diseases, there is a knowledge gap when it comes to heart failure.

“Heart failure is a condition with high morbidity and mortality,” Bene-Alhasan explained to Medical News Today. “Knowing if vaping could impact heart failure is useful in drawing up interventions to reduce the scourge of heart failure.”

For this study, Bene-Alhasan and his team reviewed data from electronic health records and surveys of more than 175,000 U.S. adults from the All of Us study, run by the National Institutes of Health.

Upon analysis, researchers found that people who used e-cigarettes at any point in their lives were 19% more likely to develop heart failure than those who had never used e-cigarettes.

“This was not too surprising (a finding) as previous studies have hinted at a risk of harm with e-cigarette use,” Bene-Alhasan said.

“A recent meta-analysis in NEJM found that vaping increased (the) risk of cardiovascular disease among others. Animal studies have also found changes in the heart leading to reduced contractility and relaxation after exposure to e-cigarettes. These are the same changes seen in heart failure,” he added.

The scientists also found e-cigarette use had the biggest impact on a certain type of heart failure.

In this study, researchers report that the increased heart failure risk linked to e-cigarette use was statistically significant for heart failure with preserved ejection fraction. Conversely, the association was not significant for heart failure with reduced ejection fraction.

Heart failure with preserved ejection fraction — also known as diastolic heart failure — occurs when the heart can pump normally, but the muscle is too stiff to allow it to properly fill with blood.

Heart failure with reduced ejection fraction happens when the heart muscle is weakened and the left ventricle is not able to contract strong enough to move blood.

“Heart failure with preserved ejection fraction is relatively less understood but is gaining more recognition,” Bene-Alhasan said.

“The traditional medicines used to treat heart failure have less mortality benefits in this type of heart failure. As such, its management should include strategies to prevent it from developing in the first place. Knowing that e-cigarettes could potentially lead to this type of heart failure is important (in) drawing up preventive interventions,” he explained.

As e-cigarettes and other vaping products are considered “safer” than cigarettes, why would using an e-cigarette or other vaping product potentially increase a person’s risk for heart failure?

“‘Safer’ is not the same as ‘safe’,” Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in this study, told MNT.

“We know in other studies that nicotine itself has deleterious effects on the heart. Specifically in e-cigarettes, it’s the nicotine that affects how the heart functions efficiently and causes worsening cardiovascular outcomes. The short answer is it’s the nicotine — we know the nicotine is not good for you.”
— Cheng-Han Chen, MD

“E-cigarettes have been known to have nicotine as well and cigarette smoking has been known to increase the risk of heart failure, so it makes sense that we might see this with e-cigarettes,” said Jennifer Wong, MD, a board certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was also not involved in this study.

“There [are] also aerosol products in e-cigarettes that could affect the respiratory function, and that may lead to worsened heart failure as well,” she said.

“E-cigarettes contribute to inflammation and increase levels of lipids in the blood. These lead to atherosclerosis, a risk factor for many cardiovascular diseases including heart failure,” Bene-Alhasan added.

Bene-Alhasan said doctors should make their patients aware of this association between e-cigarette use and increased heart failure risk, as well as other known associations.

“Although more research is required, patients still need to know what we know about it now so they can make informed decisions,” he continued.

Our findings should lead to more research on the effects of vaping. Our study has some limitations and ideally, causal studies — randomized clinical trials — should be conducted to corroborate our findings. Also, studies should be conducted in other populations, especially in those at high risk of developing heart failure,” he added.

Chen said this study’s results add to the need to increase public awareness of the dangers involved in vaping and e-cigarettes.

“This should really lead to more public outreach campaigns and public service announcements regarding the safety of e-cigarettes,” he said.

Wong told MNT she found this research to be useful information to be able to share with patients, especially when trying to educate them about preventive measures for heart failure.

“It would be interesting to see what the mechanism of e-cigarette effects are on heart failure and the heart in general — is it a rise in blood pressure, is it increased atherosclerosis, or is it more of a respiratory effect that’s indirectly affecting the heart?” she added.