When you hear the phrase “smoking kills” — which it does: nearly 500,000 Americans die from cigarette smoking each year — where does your mind go?

Many people think of lung cancer, and rightfully so.

More than three-quarters of lung cancers are caused by smoking.

Tobacco smoke contains over 7,000 chemicals, including tars that harm the lungs and cardiovascular system, and 60 known carcinogens that are inhaled with each puff of the cigarette.

Smokers, however, are more likely to die from heart disease than lung cancer.

In fact, one study found that more than half of adult smokers between 40 and 59 years old were almost twice as likely to die of a fatal heart attack or stroke.

But what about vaping?

Initially marketed as a means for quitting smoking, the e-cigarette market has boomed, increasing by 34.7% from early 2020 to mid-2024.

More than 6,000 vape products are available in the United States, yet research into them is relatively new.

“The difficulty is that every vaping product is different, so it is harder to identify and the link the disorders to which they are contributing,” said Geoffrey Williams, M.D., Ph.D., a physician at the University of Michigan Health Frankel Cardiovascular Center who specializes in lipid management and health behavior, including tobacco dependence.

“While people think vaping is safer, I never recommend it, except as the very last option when people cannot quit cigarettes on their own and can’t use the FDA-approved medications for nicotine dependence.”

Here, Williams talks about e-cigarettes, how vaping affects the cardiovascular system and your overall health.

Does vaping help you quit smoking?

Williams: Just like cigarettes, most vapes contain nicotine. Nicotine, when rapidly delivered to the brain, is highly addictive. Both cigarettes and vapes deliver nicotine in this way.

The difference is that the tobacco combustion is replaced with the heating of nicotine-based e-liquid.

In both cases, the smoker inhales, and the nicotine is shot through to the brain’s reward circuits in seconds.

Cigarettes may give a better “high,” but the inhaled nicotine keeps the brain addicted to nicotine, subject to withdrawal and possible relapse to smoking.

The Food and Drug Administration regulates e-cigarettes as tobacco products, not as medication products, and has not evaluated any of them for medical use as a tool to quit smoking.

Every major agency, from the United States Preventive Services Task Force to the Centers for Disease Control and Prevention, recommend that smokers use one of the seven FDA-approved medications to help quit and to only use e-cigs or vapes as a final resort.

Some studies have shown e-cigarettes to be effective at helping people quit smoking in the short term, but they still leave users addicted to nicotine and exposed to harmful chemicals.

In fact, people who vape may begin smoking cigarettes, which is known as dual use.

In a 2019 smoking cessation trial based in the United Kingdom, 25% of participants in the e-cig group became dual users.

This is especially worrying for younger people, who use vapes more than any other tobacco product.

Is vaping safer than smoking cigarettes?

Williams: In some ways, but the short answer is no.

Smoking anything is not healthy. Studies have shown that e-cigarette use is linked to both pulmonary and cardiovascular issues (which we will cover in a later question).

The e-cigarette doesn’t contain the thousands of chemicals found in a cigarette, but there are still a number that are harmful to the body including the hydrocarbon that delivers the nicotine into the lungs, and flavorings.

For example, they can produce chemicals like acrolein and formaldehyde, which can contribute to lung injury and disease. 

While quitting smoking is shown to mitigate the chronic decline in lung function seen in smokers, there is no evidence to show that vaping improves lung function or respiratory health in smokers.

How does vaping affect the heart?

Williams: Despite limited research, nearly all available evidence points to e-cigarette use being harmful to the entire cardiovascular system.

Vaping has been found to increase both heart rate and blood pressure.

It can put your cardiovascular system in a state of sympathetic activation, meaning it is basically in fight or flight. This poses long term risks for your heart.

Long term use of e-cigarettes can also damage the function of your blood vessels.

One reason this occurs is because your blood vessel cells may produce around 30% less nitric oxide, which is needed to relax the vessels and improve blood flow.

Vaping every day can nearly double your risk of having a heart attack — and that risk compounds for dual users compared to people who don’t use either product.

While we do not yet know if using e-cigarettes triggers heart failure, a 2024 study found that people who had used them were around 20% more likely than non-users to develop the condition.

Even for people trying to quit, using e-cigarettes or other nicotine products put users at an increased risk of cardiovascular disease compared to those who used other alternatives.

How does quitting smoking help the heart?

Williams: Just like with cigarettes, quitting vaping reduces your exposure to nicotine and many toxic chemicals that can harm the heart and cardiovascular system.

The research on the health benefits of quitting vaping is limited, but I like to remind people of the benefits of quitting smoking cigarettes to show how much better it is to not smoke anything.

When you quit, your risk of blood clots and plaques building up in your arteries decreases.

If you already have heart disease, quitting reduces your risk of having a heart attack or dying.

Beyond the cardiovascular system, quitting can decrease the odds of being diagnosed with many cancers.

What advice do you have for quitting?

Williams: There are several ways to quit smoking.

The seven approved medications include a nicotine patches, gum, lozenges, inhalers, spray and varenicline (Chantix) and bupropion (Wellbutrin).

Stopping smoking or vaping nicotine requires managing withdrawal, changing habits or behaviors, and finding a new way to deal with stress without smoking or vaping.

To manage withdrawal, steadily decrease the number of cigarettes or vape puffs by one third each week until you get to between five and eight cigarettes, or you get to one third or a quarter of puffs you were taking.

You can also decrease the concentration of the vape steadily to get less nicotine as long as you don’t increase your number of puffs.

When you change your pattern, expect it to feel odd.

Relapse is common. If it happens, try to stop again in the next few days. Most people have to try to stop multiple times before they are successful.

Finally, work with a health care professional to coach your through the next three to six months. Working with a professional increases chance of success by two to four times compared to those who don’t.

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week.

Sign up for the Health Lab Podcast. Add us wherever you listen to your favorite shows.