Vaping Not Safer: ICMR Study Links E-Cigs to Heart Attacks

A groundbreaking and comprehensive review led by the Indian Council of Medical Research–National Institute of Cancer Prevention and Research (ICMR-NICPR) has cast a serious shadow over the perception of vaping as a safe alternative to smoking. As e-cigarette use continues to gain traction globally and within India, despite bans, this new research provides stark evidence of the cardiovascular dangers lurking behind the vapor.

By analyzing data from 12 global observational studies involving over 1.2 million participants, researchers uncovered a disturbing trend: e-cigarette users face a significantly elevated risk of myocardial infarction (heart attack) and stroke. The findings challenge the popular narrative that switching from combustible cigarettes to vapes is a risk-free move for your heart.

Key Findings: The Cardiovascular Toll of Vaping

The ICMR-led review systematically examined the association between e-cigarette use and cardiovascular events. The results were unequivocal:

• Higher Heart Attack Risk: E-cigarette users had 1.53 times higher odds of experiencing a heart attack compared to non-users. Even after adjusting for traditional cigarette smoking, the risk remained elevated at 1.24 times.
• The “Switching” Trap: Perhaps the most alarming finding concerns those who switch from smoking to vaping. Former smokers who used e-cigarettes faced a 2.52 times higher risk of myocardial infarction compared to individuals who had quit tobacco and nicotine products entirely.
• Stroke Risk: The study found a similar pattern for stroke risk, with former smokers using e-cigarettes showing substantially higher risks than non-users.

These statistics directly challenge the belief that e-cigarettes are a harmless substitute. While they may lack the tar and carbon monoxide of traditional cigarettes, they still deliver nicotine—a potent vasoconstrictor that raises heart rate and blood pressure—along with other toxic compounds that can damage blood vessels and increase platelet activity.

The study concluded that e-cigarette use is linked with a higher risk of both heart attack and stroke, emphasizing the need for further longitudinal studies to confirm these findings and guide policy.

Why Vaping Hurts the Heart

While e-cigarettes are often marketed as safer, health experts warn this is misleading. Dr. (Prof) Tarun Kumar, Associate Director and Head of the Medanta Moolchand Heart Centre, stated that the ICMR review reinforces long-standing cardiological concerns.

“E-cigarettes pose serious health risks, including addiction to nicotine, lung damage such as EVALI, asthma, COPD and even lung scarring. They are also linked to cardiovascular problems like high blood pressure and vascular dysfunction,” Dr. Kumar explained. He noted that users are exposed to cancer-causing chemicals, heavy metals, and volatile organic compounds.

Dr. Kumar was unequivocal about the comparison: “Vaping is not a harm-reduction tool for heart health. It is equally harmful, and in some cases worse than conventional cigarette smoking.” He highlighted that symptoms like breathlessness in vapers can indicate cardiac involvement, not just lung issues.

The Indian Context: A Ban Challenged by Reality

India has taken a firm regulatory stance. E-cigarettes have been banned in India since 2019 under the Prohibition of Electronic Cigarettes Act (PECA). This law prohibits the production, manufacture, import, export, transport, sale, distribution, storage, and advertisement of these devices.

However, enforcement remains a significant challenge. A Lancet commentary noted that despite the ban, e-cigarettes have entered the market through various marketing strategies and a thriving black market, threatening the country’s tobacco control efforts. “The 2019 ban was a right, timely, and important public health decision, but preventing use of e-cigarettes, especially in adolescents, still remains a challenge,” the commentary warned.

Recent data supports this concern. A 2023 study on educated young adults in India found that despite the ban, 23% had used e-cigarettes, with access primarily through retail outlets and social networks. Alarmingly, 31% of non-users expressed curiosity about trying them. Another 2023 review titled ‘Impact of Vaping on Lungs: An Indian Prospect’ highlighted the growing popularity of vape pens among youth, noting they are often used without awareness of their numerous side effects.

Broader Health Implications: Mental Health and More

The impact of vaping extends beyond the heart and lungs. A 2025 editorial on vaping’s psychiatric implications in India warned of the mental health consequences of nicotine addiction, calling it a “multifaceted public health challenge.”

Furthermore, a recent umbrella review synthesizing 69 systematic reviews confirmed consistent evidence of increased risks across multiple organ systems for users of electronic nicotine delivery systems (ENDS). This included not just cardiovascular and respiratory issues, but also mental health concerns like depression and suicidality among adolescents.

Government Response and Future Directions

In a written reply in the Rajya Sabha, Minister of State for Home Affairs Nityanand Rai reaffirmed the prohibition under PECA 2019. He outlined measures to strengthen surveillance at airports and ports to curb smuggling, including the use of canine squads and advanced scanning technology. Responsibility for enforcement lies with state and Union Territory law enforcement agencies.

Dr. Kumar emphasizes that while the ban is essential, it cannot work in isolation. “Regulation and advisories cannot be one-time measures. Public memory is short, so enforcement and awareness have to be continuous,” he said, calling for sustained educational campaigns in schools and media to counter the growing appeal of vaping among youth.