Vaping And Strokes: Is There A Link?

Vaping is a growing trend, especially among teens, with an estimated one in 20 Americans using e-cigarettes. While e-cigarettes are tobacco-free, they still contain harmful substances, including heavy metals, volatile organic compounds, cancer-causing agents, and high concentrations of nicotine.

Research has shown that vaping increases the risk of stroke, heart attack, and coronary heart disease. A study published in the Journal of the American Heart Association found that vaping caused the blood's clot-forming platelets to become hyperactive, resulting in the formation of blood clots, increasing the risk of a heart attack or stroke.

Another study in the American Heart Association Journal tested nine chemical flavourings commonly used in e-cigarettes and found that all nine chemicals caused cell death at the highest levels tested, with particular sensitivity to burnt flavour, vanilla, cinnamon, and clove flavourings. Even at low concentrations, these chemicals caused blood vessel inflammation, which can lead to stroke.

While vaping is often marketed as a safer alternative to smoking, the research suggests that it may not be a safe substitute and can increase the risk of stroke, especially in younger people.

Vaping and blood clotting

Vaping is the act of inhaling and exhaling aerosol, often referred to as vapour, produced by a battery-powered device that can deliver nicotine and flavourings. While vaping is often marketed as a safer alternative to smoking, it has been linked to an increased risk of stroke, heart attack and coronary heart disease.

Blood Clotting

A study published in the Journal of the American Heart Association in 2018 found that the blood's clot-forming platelets in mice exposed to e-cigarette vapours became hyperactive, resulting in the formation of blood clots and an increased risk of a heart attack or stroke.

Another study published in the same year in the American Heart Association Journal showed that nine common e-cigarette flavourings caused cell death in endothelial cells at the highest levels tested. Endothelial cells line the blood vessels and the inside of the heart, helping to control vascular relaxation and contraction as well as blood clotting. At lower concentrations, the chemicals caused blood vessel inflammation, which can also lead to stroke.

In humans, a 2023 study found that sole e-cigarette use, sole combustible cigarette use, and dual use of combustible and electronic cigarettes were all significantly associated with the prevalence of stroke.

Nicotine

Nicotine is a harmful chemical that increases blood pressure and is found in both combustible cigarettes and e-cigarettes. It is a major contributing factor to the increased risk of blood clots and strokes in people who smoke or vape.

Other Chemicals

In addition to nicotine, e-cigarettes contain many harmful constituents, such as diacetyl, fine ultrafine particles, heavy metals, and carbonyl compounds. These chemicals can generate harmful volatile organic compounds at high temperatures, including acetaldehyde and formaldehyde, which may also contribute to the increased risk of blood clots and strokes.

While the long-term effects of vaping are still being studied, the available evidence suggests that vaping may not be a safe alternative to smoking combustible cigarettes. Vaping has been linked to an increased risk of blood clots and strokes, and this risk may be higher for dual users of combustible cigarettes and e-cigarettes.

Vaping and heart attacks

Vaping is a popular alternative to smoking tobacco cigarettes, but it is not without its risks. While vaping is often marketed as a safer alternative to smoking, research suggests that it may still cause serious health issues, including an increased risk of heart attacks.

Vaping involves inhaling and exhaling aerosol, often referred to as vapor, produced by a battery-powered device that can deliver nicotine and flavorings. While e-cigarettes are tobacco-free, they can still contain harmful substances, including heavy metals, volatile organic compounds, cancer-causing agents, and high concentrations of nicotine.

Research has found that vaping can affect the vasculature, specifically the endothelium (the inner lining of blood vessels). One study showed that vaping caused acute changes in flow dynamics, consistent with endothelial dysfunction, in healthy nonsmokers. This included decreased hemoglobin saturation, suggesting microvascular dysfunction, as well as stiffening of the aorta. These changes are significant because alterations in blood vessel function can lead to a heart attack.

Additionally, vaping has been shown to increase the risk of blood clots, which can block blood flow to the heart and lead to a heart attack. A study published in the Journal of the American Heart Association found that exposure to e-cigarette vapors caused the blood's clot-forming platelets to become hyperactive, resulting in the formation of blood clots and an increased risk of a heart attack.

While vaping is often promoted as a safer alternative to smoking, the evidence suggests that it may still carry significant risks. Some studies have found that vaping may increase the risk of a heart attack to a similar degree as smoking. However, other studies suggest that vaping may be less harmful than smoking in terms of heart attack risk.

One study found that smokers who switch to vaping have a lower overall risk of stroke. While vapers and dual users (those who smoke and vape) who suffer strokes tend to have them earlier in life, their overall stroke risk is much lower than that of smokers. This is consistent with the well-established dose-response relationship between smoking and stroke risk; the fewer cigarettes smoked, the lower the risk.

Quitting vaping can be a challenging but important step to reduce the risk of heart attacks and improve heart health. Nicotine replacement therapy and smoking cessation medications can help manage cravings and withdrawal symptoms. Counseling and support from a doctor or counselor who specializes in smoking cessation can also be beneficial.

It is important to note that more research is needed to fully understand the long-term effects of vaping on heart health and to compare the relative risks of vaping and smoking.

Vaping and youth

Vaping is the most common form of tobacco use among young people in the US, with e-cigarettes being used more than any other tobacco product by middle and high school students. In 2024, 5.9% of middle and high school students currently used e-cigarettes, with 3.5% of middle school students and 7.8% of high school students vaping.

The rise in vaping among young people has been linked to targeted marketing by e-cigarette companies, with advertising heavily aimed at adolescents. The products are designed to appeal to young people, with fun packaging and flavoured pods. The devices are also designed to look like USBs, pens, and inhalers, and can be personalised like a phone case.

The rise in vaping among young people is particularly concerning given the significant health risks that e-cigarettes pose to teens. E-cigarettes often contain higher concentrations of nicotine than combustible cigarettes, and nicotine causes problems for the developing brain. Adolescent brains are still developing, and nicotine exposure has been linked to cognitive deficits and impairment in memory and executive function. Nicotine addiction often originates in adolescence, and young people who vape are more likely to become addicted and have more difficulty quitting.

Vaping is also linked to an increased risk of using combustible cigarettes and marijuana later in life. One study found that adolescents who use e-cigarettes are 3.6 times more likely to report using combustible cigarettes later in life, and another found that teens who use nicotine liquid in e-cigarettes are 3.6 to 4 times more likely to use marijuana in the next two years.

Preventing Youth Vaping

Many people have an important role in protecting youth from vaping, including parents and caregivers, educators and school administrators, health care providers, and community partners. It is imperative that teens are given accurate information about the dangers of vaping, and that parents are also educated so they can discuss the risks with their children.

States and local communities can also implement evidence-based policies, programs, and services to reduce youth vaping. For example, increasing the cost of cigarettes to the consumer has been shown to decrease overall cigarette consumption.

Vaping and smoking cessation

Vaping has become a popular method for smoking cessation, especially among young people. However, it is important to note that vaping is not a proven or approved method for quitting smoking. The long-term safety and efficacy of vaping devices as a tool to quit smoking are still uncertain.

Health Risks of Vaping

Vaping devices deliver nicotine to users by aerosolizing a nicotine-containing solution. While e-cigarettes are tobacco-free, they can still contain harmful substances, including heavy metals, volatile organic compounds, cancer-causing agents, and high concentrations of nicotine.

Research has shown that vaping increases the risk of stroke, heart attack, and coronary heart disease. Studies have found that vaping can cause changes in blood vessels and the heart, leading to an increased risk of blood clots, which can result in a stroke or heart attack.

Alternative Methods for Smoking Cessation

If you are looking for alternatives to vaping to help you quit smoking, there are other proven methods and tools available. The American Lung Association offers a voluntary quit-smoking program called "Not On Tobacco" (NOT) for teens. This program helps participants identify their reasons for smoking and learn healthy alternatives to tobacco use.

For adults, the Freedom From Smoking program is one of the most effective cessation programs in the country and is available in a variety of options to support your journey to becoming smoke-free.

Remember, it is important to keep trying to quit, and you don't have to do it alone. Family, friends, and healthcare professionals can provide help and support throughout your journey.

Vaping and lung injury

Vaping is the act of inhaling and exhaling aerosol, often referred to as vapour, produced by a battery-powered device that can deliver nicotine and flavourings. While e-cigarettes are tobacco-free, they can still contain harmful substances including heavy metals, volatile organic compounds, cancer-causing agents, and high concentrations of nicotine.

E-cigarettes and Vaping: The Technology

E-cigarettes come in a variety of designs and complexity but typically contain a battery, heating coil, an atomizer that transforms the nicotine-containing liquid into an aerosol, a cartridge containing the liquid, and a mouthpiece. When a user inhales, the heating element is activated, vaporizing a fixed quantity of the nicotine-containing e-liquid, which is then drawn into the user's mouth, then lungs, and bloodstream.

Some of the chemicals in e-cigarettes, beyond nicotine, include propylene glycol and/or vegetable glycerine, which have been shown to induce lung and airway inflammation. In addition, these volatile organic compounds can cause damage to the liver, kidney, and nervous system.

E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI)

The chemical thought to be the primary contributor to EVALI is Vitamin E Acetate. In a recent study, 48 out of 51 patients with confirmed or presumed EVALI had Vitamin E Acetate collected from their Bronchoalveolar Lavages (BAL), whereas the control group had none. Another study evaluated mice exposed to Vitamin E Acetate and found that those exposed had pulmonary injury evaluated by albumin in BAL fluid, as well as increased White Blood Cell (WBC) counts.

As of February 2020, the total number of hospitalized e-cigarette/vaping-associated lung injuries or deaths was 2807, with 68 of these being deaths. Other studies of EVALI patients showed that 96% required hospitalization, with 26% requiring intubation.

E-cigarette and Vaping: Stroke Risk

Vaping products have been shown to affect the vasculature, specifically the endothelium (i.e. the inner lining of blood vessels). A recent study demonstrated that after inhalation by healthy nonsmokers of e-cigarette vapour, there was an acute change in flow dynamics consistent with endothelial dysfunction. This study further demonstrated a decrease in hemoglobin saturation, suggesting microvascular dysfunction, as well as stiffening of the aorta. All of these changes are significant since alterations in blood vessel function can be associated with stroke.

While the long-term safety of e-cigarettes is still uncertain, current evidence suggests that vaping products can cause lung and airway injury and affect the vasculature, specifically the endothelium. Further research is needed to better understand the risks associated with e-cigarette use.

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