Long-term cardiovascular and respiratory health effects of e-cigarette use: a narrative review of emerging evidence

Abstract Background The rapid rise in e-cigarette use has generated increasing public health concern regarding its long-term effects on the cardiopulmonary system. Although e-cigarettes are often marketed as a safer alternative to traditional tobacco products, growing evidence suggests they may contribute to chronic respiratory and cardiovascular diseases. Methods This contemporary narrative review synthesizes current research published between 2015 and 2025 on the long-term respiratory and cardiovascular consequences of e-cigarette use, integrating findings from epidemiologic, clinical, and mechanistic studies. Results and Discussion Evidence consistently links frequent e-cigarette use to elevated risks of chronic obstructive pulmonary disease (COPD), asthma exacerbation, impaired lung function, myocardial infarction, arrhythmias, and endothelial dysfunction. Mechanistic data reveal nicotine-induced sympathetic activation, oxidative stress, and vascular injury as key biological pathways underlying these effects. Older adults and daily users appear particularly vulnerable due to cumulative exposure and reduced physiological resilience. Despite these concerning trends, substantial gaps remain, including limited longitudinal data, inconsistent exposure characterization, and inadequate distinction between exclusive and dual users. Conclusions Addressing these gaps through well-designed cohort and mechanistic studies will be critical to refining clinical guidance, informing regulatory policy, and shaping evidence-based public health messaging.