Are E-Cigarettes Safe? New Study Highlights Potential Health Risks

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For years, electronic cigarettes have lived in a gray zone — marketed as safer than smoking but never quite proven harmless.

As their popularity surges, especially among young adults, the science is finally starting to catch up. Now, a large-scale study led by researchers at Johns Hopkins sheds new light on the health risks of vaping, offering early answers — and raising new concerns.

“These results are a critical stepping stone for future prospective research on the health effects of e-cigarettes,” said lead researcher Michael Blaha, M.D., M.P.H., professor of cardiology and epidemiology at the Johns Hopkins University School of Medicine, in a news release. “While in this short-term study there was no association between exclusive e-cigarette use and cardiovascular events, there was an association with incident COPD and possibly hypertension that will need to be closely watched over longer term follow-up.”

After decades of progress in the fight against tobacco in the form of reducing smoking rates, e-cigarette use is now threatening to buck the trend of declining nicotine use in the U.S.

According to data from the National Health Interview Survey, the percentage of adults who used e-cigarettes increased from 4.5% in 2019 to 6.5% in 2023. In both 2019 and 2023, men were more likely than women to use e-cigarettes. In 2023, young adults ages 21 to 24 were most likely to use e-cigarettes, with a usage rate of 15.5%.

Despite this rising prevalence in use, many questions remain regarding the effects of e-cigarette use on overall health.

Led by Blaha, with financial support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the Center for Tobacco Products at the Food and Drug Administration, the current study used data from the All of Us Research Program to explore whether e-cigarettes are linked to health problems like high blood pressure, diabetes, lung disease and heart conditions.

Launched in 2015 by the NIH, the All of Us Research Program contains more than 1,307,000 people who have registered with the program by creating online accounts at JoinAllofUs.org. From the database, Blaha and researchers obtained data from more than 249,000 adults for nearly four years.

Participants were grouped by what they used: only e-cigarettes, only regular cigarettes, both or neither.

Results of the study showed people who only used e-cigarettes did not show a significantly higher risk for most conditions, like diabetes, heart failure or heart disease. However, they were more than twice as likely to develop chronic lung disease (COPD) than nonusers. Among adults aged 30 to 70, e-cigarette use was also linked to a 39% higher risk of high blood pressure.

Those who smoked only traditional cigarettes or used both e-cigarettes and cigarettes had higher risks for all conditions studied. Dual users, in particular, were more than twice as likely to develop serious heart disease.

“There remains great uncertainty about the relative harm of e-cigarettes as compared to traditional smoking. Until now, there has been scant longitudinal data in large high-quality data sets linking exclusive e-cigarettes use to new-onset cardiometabolic health conditions,” Blaha added.