Published in the BMC Public Health, the study analysed data from over 1.2 million participants across 12 studies and found that the cardiovascular dangers of e-cigarettes persist even after accounting for conventional cigarette smoking. (File)
Electronic cigarettes pose serious cardiovascular risks with users facing 53% higher risk of heart attacks compared to non-users, according to a new review and meta-analysis led by scientists at the Indian Council of Medical Research-National Institute of Cancer Prevention and Research (ICMR-NICPR). In fact, former cigarette smokers who switched to e-cigarettes faced more than double the heart attack risk compared to those who quit tobacco entirely.
Published in the BMC Public Health, the study analysed data from over 1.2 million participants across 12 studies and found that the cardiovascular dangers of e-cigarettes persist even after accounting for conventional cigarette smoking. “This research shatters the myth that e-cigarettes are harmless alternatives to conventional smoking,” said Dr Shalini Singh, Director of ICMR-NICPR and WHO FCTC Knowledge Hub on Smokeless Tobacco. She is also senior author of the study.
The findings demonstrate that nicotine damages the heart and blood vessels regardless of how it is delivered, researchers said, adding that this has implications for India’s public health policy and validates the country’s 2019 decision to ban e-cigarettes.
Why the misconception around e-cigarettes?
Dr Vijay Natarajan, chief of Cardiac Surgery at Poona Hospital (not associated with the study), said the perception of e-cigarettes as safe and risk-free is absolutely false. “The misconception stems from the fact that e-cigarettes do not emit smoke and hence are perceived as less harmful. However, the most dangerous component in cigarettes is nicotine which is found in equal measure in e-cigarettes. This meta-analysis provides conclusive proof that the risks of myocardial infarction (MI) and stroke remain significantly higher among e-cigarette users as compared to non-smokers,” he said.
The study’s lead author, Dr Ruchika Gupta, a scientist at ICMR-NICPR, explained that nicotine triggers a cascade of harmful effects in the body. “It increases heart rate and blood pressure, damages the protective lining of blood vessels, promotes blood clot formation and accelerates the buildup of plaque in arteries. These effects occur whether nicotine comes from a conventional cigarette or an e-cigarette,” she said. In fact, most of the young heart attack patients in India happen to be smokers.
What the study found
Researchers reviewed 12 studies providing a total of 26 estimates – 11 for myocardial infarction (MI) (67,253 e-cigarette users and 363,622 non-users) and 15 for stroke (121,113 e-cigarette users and 1,064,228 non-users). They found that e-cigarette users had 1.53 times higher odds of experiencing a heart attack compared to non-users. Even when researchers accounted for conventional cigarette smoking as a confounding factor, e-cigarette users still showed 1.24 times higher heart attack risk. The stroke risk followed similar patterns, with former smokers who switched to e-cigarettes facing 1.73 times higher stroke risk.
Perhaps the most troubling finding from the study concerns people who switched from conventional cigarettes to e-cigarettes, believing they were making a healthier choice. The research team found these individuals faced 2.52 times higher risk of heart attack and 1.73 times higher risk of stroke compared to people who quit tobacco products entirely. Dr Prashant Kumar Singh, nodal officer of the WHO FCTC Global Knowledge Hub on Smokeless Tobacco at ICMR-NICPR and co-lead author, describes this as the “harm reduction trap.” As he explained, “The tobacco industry has been remarkably successful in promoting e-cigarettes as harm reduction tools, especially targeting people trying to quit smoking. But our research shows this narrative is fundamentally flawed. They tell smokers, don’t quit, just switch. But switching means continued nicotine addiction, continued cardiovascular damage, and continued industry profits. True harm reduction means quitting all tobacco and nicotine products, using evidence-based methods with proper medical support.”
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“When tobacco users want to quit but are told e-cigarettes are an option, we are failing them,” Dr Singh said and urged there was a need to massively scale up access to proven cessation methods that don’t simply substitute one form of nicotine for another. “This means behavioural support, counselling services and most importantly, non-nicotine pharmacological options,” he added.
Study authors said that the message from this study is clear: India has made the scientifically sound decision to prohibit e-cigarettes. Now the challenge is implementation — strict enforcement, youth protection, and providing genuine alternatives for those seeking to quit tobacco.
Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues .
Professional Background
Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature.
Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO.
Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives.
Awards and Recognition
Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.”
Recent Notable Articles (Late 2025)
1. Cancer & Specialized Medical Care
"Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease.
Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose.
2. Environmental Health (The "Breathless Pune" Series)
Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs.
"For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune.
3. Lifestyle & Wellness News
"They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions.
At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents.
4. Scientific Recognition & Infrastructure
For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics.
Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far.
Signature Beat: Health, Science & Women in Leadership
Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions.
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