- Exclusive vaping substantially reduces exposure to toxic chemicals linked to cardiovascular disease compared with cigarette smoking, the review found.
- Smokers who switched completely showed favourable changes in markers linked to inflammation, blood clotting, cholesterol and blood-vessel health.
- Population studies generally associated exclusive vaping with lower cardiovascular risk than continued smoking, while dual use often offered little or no reduction.
- The authors said longer-term studies are needed to establish the effects of individual products.
Smokers who switch completely from cigarettes to vaping could substantially reduce their risk of cardiovascular disease compared with those who continue smoking, according to a new review of laboratory, clinical and population evidence.
The narrative review, published in the journal Cureus, examined research on vapes, heated tobacco products and oral nicotine pouches.
Its authors concluded that using smoke-free nicotine products exclusively was associated with sharply lower exposure to many of the toxic chemicals responsible for smoking-related heart disease.
However, the paper stressed that the greatest potential benefit came from eliminating cigarettes completely. People who continued to smoke while also vaping frequently had cardiovascular risk levels similar to those who smoked exclusively.
Toxicant exposure falls after switching
Cigarette smoke contains chemicals including carbon monoxide, acrolein, benzene and hydrogen cyanide, which can damage blood vessels, increase inflammation and oxidative stress, and promote the formation of blood clots and fatty deposits in arteries.
Because vapes do not burn tobacco, users are generally exposed to much lower levels of these combustion-related toxicants.
The review examined clinical studies that measured biological signs of exposure after smokers switched to vaping. Many reported significant reductions in chemicals linked to cardiovascular disease, with levels in some exclusive vapers approaching those seen in people who stopped using tobacco and nicotine altogether.
Studies also found favourable changes in markers associated with potential harm. These included lower levels of platelet activation, inflammation and oxidative stress, as well as improvements in HDL cholesterol, sometimes known as “good” cholesterol.
One 24-week trial found favourable changes in five cardiovascular-related markers among smokers who switched to a pod-based vape, including white blood cell counts and markers of platelet activity and blood-vessel damage.
Other research recorded reductions in blood pressure and heart rate after smokers partially or completely replaced cigarettes with vapes, while a UK trial found improved blood-vessel function within one month of switching.
Complete switching appears crucial
The review found an important difference between people who moved entirely away from cigarettes and those who continued to smoke and vape.
Several population studies found cardiovascular biomarkers among exclusive vapers were closer to those of former smokers or non-users than current smokers.
Dual users, however, often had biomarker levels and cardiovascular risks similar to exclusive smokers. In some studies, their estimated risk was higher, although the authors said this could partly reflect heavier or longer histories of cigarette use.
Even smoking a small number of cigarettes can substantially increase heart disease and stroke risk, meaning simply cutting down may deliver less protection than smokers expect.
The paper said dual use may be a temporary stage while people move away from cigarettes, but that the period should be kept as short as possible.
Recent studies report fewer cardiac events
The review’s findings are supported by recent observational research involving people who already had a high risk of cardiovascular disease.
A 2025 South Korean study followed 17,973 smokers who had undergone treatment to reopen narrowed or blocked coronary arteries.
Over a median of 2.4 years, major adverse cardiac events were recorded in 10.8 per cent of those who switched to vapes, compared with 17 per cent of those who continued smoking and 13.4 per cent of those who quit.
After adjustments, switching was associated with an 18 per cent lower risk than continued smoking. People who switched completely also had a 29 per cent lower risk than those who continued using both cigarettes and vapes. As an observational study, however, it could not prove that switching directly caused the difference.
A separate 2026 study followed 23,262 South Korean adults who smoked when they were diagnosed with chronic obstructive pulmonary disease.
Those classed as switching to vapes had a 20 per cent lower adjusted risk of major adverse cardiac and cerebrovascular events than those who continued smoking.
The study did not find comparable reductions in lung cancer or COPD
exacerbations. Most of the vape group included people who still smoked, while only 393 participants switched completely, limiting the conclusions that could be drawn about exclusive vaping.
Evidence on absolute cardiovascular risk remains less certain. A 2025 US study involving nearly 250,000 people found exclusive vaping was not significantly associated with heart failure or atherosclerotic cardiovascular disease overall.
The study found no significant overall association between exclusive vaping and heart failure or atherosclerotic cardiovascular disease, although it did identify associations with hypertension among people aged 30 to 70 and with COPD.
Evidence points to lower cardiovascular harm than smoking
The review found that while vaping is not risk-free, its cardiovascular effects are generally much smaller than those associated with smoking. Nicotine can temporarily raise heart rate and blood pressure, and some studies have detected short-term changes in blood-vessel function, inflammation and oxidative stress, but these effects were typically less pronounced than after smoking a cigarette.
Most population studies are observational, so researchers must account carefully for factors including previous smoking, age, underlying health and whether disease developed before or after vaping began.
Even with those limitations, evidence from laboratory, clinical and population studies generally pointed towards lower cardiovascular harm when smokers switched completely.
Regulators have authorised reduced-exposure claims for some smoke-free products, reflecting lower exposure to particular toxic chemicals, although no product has yet been approved to claim a reduction in disease risk.
The paper was a narrative review rather than a systematic review or meta-analysis, making further independent, long-term and product-specific research important.
Taken together, the authors said the evidence indicates that smokers who replace cigarettes completely with vaping are likely to face considerably less cardiovascular harm than those who continue to smoke.
