Vaping Linked to Higher Risk of HFpEF, NIH Data Show

ATLANTA, GA—The health consequences of e-cigarettes may extend to increasing the risk of heart failure with preserved ejection fraction (HFpEF), new data suggest.

After adjustment for demographic and socioeconomic factors, diabetes, hypertension, hyperlipidemia, body mass index, and concomitant substance use, researchers found that people who reported a history of vaping had about a 19% higher risk of new incident heart failure compared with those who never used e-cigarettes.

“One message from our study is that e-cigarettes are not as safe as they are perceived to be,” said Yakubu Bene-Alhasan, MD, (MedStar Health, Baltimore, MD), who presented the study at the American College of Cardiology 2024 Scientific Session.

Bene-Alhasan and colleagues examined data using surveys and electronic health records from the National Institutes of Health’s diversified All of Us research program. Over a median follow-up of 45 months, there were 3,242 new HF diagnoses in 175,667 adults.

Overall, the risk of new incident HF was higher in users of electronic nicotine products compared with never users (adjusted HR 1.19; 95% CI 1.06-1.35). When broken down by type, users of e-cigarettes also had a greater risk of developing HFpEF (adjusted HR 1.21; 95% CI 1.01-1.47), but no association was seen for development of HF with reduced ejection fraction (HFrEF; adjusted HR 1.11; 95% CI 0.90-1.37).

Additionally, no associations were seen between the frequency of vaping and HF, and there was no evidence that age, sex at birth, or concomitant use of cigarette smoking modified the observed relationship between e-cigarettes and HF.

E-cigarettes are not as safe as they are perceived to be. Yakubu Bene-Alhasan

Bene-Alhasan told TCTMD that more research on the health effects of e-cigarettes is needed, particularly in younger populations, since the median age in this study was 52. “We did not include participants below the age of 18, and we know that vaping is very common among those in high-school and middle-schoolers as well,” he added. “But for the time being, we should continue to discourage the use of e-cigarettes among the youth.”

Some recent data suggest that after a period of decline, e-cigarette use is increasing in people with CVD, and that vaping does not decrease the CV risks in people who continue to smoke combustible tobacco products.

Bene-Alhasan said the current study is a good reminder to clinicians to be persistent in asking their patients about e-cigarette use. “We need to get a more extensive history from patients about their use of these products, how often they are vaping, so we can encourage them to stop,” he noted.