Smokers switching to e-cigarettes have an increased heart attack risk, says ICMR study: Why quitting smoking is the only way out

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.”

How to quit nicotine of all kinds

“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.