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E-cigarettes are relatively new and despite their wide-scale adoption, many of their health effects are still not thoroughly assessed. What we seem to know with a high degree of confidence so far is that vaping is much less taxing on health than smoking tobacco. What we also know is that vaping isn’t harmless or risk-free. A recent study adds to a body of evidence that suggests e-cigarettes have significant impacts on human health, particularly on the lungs, heart, and mental health.

Researchers at the University of Kansas School of Medicine-Wichita analyzed data from the Centers for Disease Control and Prevention’s National Health Interview Surveys in 2014, 2016, and 2017, which included a total of 96,000 people. Compared to individuals who do not smoke or vape, e-cig users were 56% more likely to have a heart attack and 30% more likely to have a stroke. Similarly, higher rates of coronary artery disease and blood clot rates were seen in e-cig users.

Vapers were also more likely to suffer from mental health issues, being twice as likely to suffer from depression, anxiety, and mood swings.

The findings, presented at last month’s  American College of Cardiology’s 68th Annual Scientific Session, should serve as a “real wake-up call and should prompt more action and awareness about the dangers of e-cigarettes,” the researchers said. However, this was an observational study, so no cause-effect relationship between vaping and these issues was studied — only whether they’re associated or not. In this particular study, the researchers did not know whether some e-cig users among the participants were former smokers or not, which may have been an important distinction.

However, this isn’t the first study that associated e-cig to harmful effects. In a study for the Nature Reviews Cardiology journal, researchers reported that nicotine and other chemicals found in e-cigarettes can contribute to cardiovascular events, particularly in people with underlying cardiovascular disease. Although vaping does not produce the combustible products associated with smoking, e-cig vapor isn’t totally harmless to the lungs. Inhaling vapor can irritate lung, researchers reported in a study that tracked 28,000 adults.

These health risks are far less dramatic than smoking tobacco, but users should nevertheless be aware of them. This is especially true in today’s context where more and more people who never smoked tobacco are now taking up vaping — and users are getting younger and younger. According to a Vital Signs report, published by the Centers for Disease Control and Prevention, in 2018, some 4.9 million high school and middle school students used tobacco in the last 30 days, an increase from 3.6 million in 2017. This trend is amplified by aggressive marketing on behalf of e-cig manufacturers like SMOK Novo and many others.

As mentioned earlier in this article, e-cigs are still relatively new so there is a lot of things we don’t know about their long-term effects, and can’t possibly know until they occur in the general population. This makes vaping a huge challenge to regulators but also to scientists who have the responsibility to answer big questions about the safety of e-cigarette use.