E-cigarettes and cardiovascular health: a review of components, mechanisms, and clinical risk.

Electronic cigarettes (e-cigarettes) have become one of the most urgent public health issues of the twenty-first century. Originally marketed as less harmful than burning cigarettes, e-cigarettes have gained enormous popularity, especially among young adults, thus leading to nicotine addiction and new trends of cardiovascular damage. Even though e-cigarettes limit exposure to products of combustion, they supply similar doses of nicotine and other elements such as aldehydes, metals, and flavoring by-products, whose cardiovascular effects are incompletely characterized. This narrative review addresses a comprehensive analysis of the cardiovascular effects of e-cigarettes, particularly the contribution to the development of arrhythmias and cardiomyopathy. Evidence was synthesized from in vitro, animal models, and clinical research that covers e-cigarette constituents, delivery mechanisms of toxins, and both acute and chronic cardiovascular effects. E-liquid constituents can result in an autonomic imbalance, increasing heart rate and pressure, conductivity, and the predisposition of arrhythmias and cardiomyopathies. Recent research has shown oxidative stress, endothelial dysfunction, and autonomic imbalance instigated by nicotine and non-nicotinic additives, which destabilize cardiac electrophysiology. However, most human data remain short-term, with limited sample sizes and heterogeneous exposure assessment, underscoring the lack of longitudinal evidence on long-term outcomes such as myocardial infarction, heart failure, or sudden cardiac death. The clinical and public health implications are significant, and it is imperative to shift the focus to vaping as a separate cardiovascular risk factor, particularly among young adults. To reduce the increasing burden of e-cigarette-related cardiovascular disease, preventive actions and enhanced monitoring must be prioritized. They become cardiovascular toxic through nicotine and other chemical exposures, and there is growing evidence of arrhythmogenic and cardiomyopathic effects. Strong prospective studies are urgently needed to define dose-response relationships, long-term outcomes, and cessation strategies.