A landmark review led by the Indian Council of Medical Research (ICMR) has delivered a stark warning: electronic cigarettes are far from safe. The comprehensive analysis, published in BMC Public Health in December 2025, concludes that users of e-cigarettes face a 53% higher risk of heart attacks compared to non-users, shattering the popular perception of vaping as a harmless alternative to smoking.
The Harsh Numbers: Quantifying the Cardiovascular Danger
The ICMR-National Institute of Cancer Prevention and Research (NICPR) team analysed data from over 1.2 million participants across 12 global studies. Their meta-analysis provided 26 separate estimates, painting a clear and alarming picture. The research found that e-cigarette users had 1.53 times higher odds of suffering a myocardial infarction (heart attack).
Critically, this elevated risk persisted even after scientists accounted for the confounding factor of conventional cigarette smoking. When isolating the effect of e-cigarettes alone, users still showed a 24% higher heart attack risk. The danger extended to strokes as well, with former smokers who switched to e-cigarettes facing a 73% higher stroke risk.
The "Harm Reduction Trap": Switching is Not Quitting
Perhaps the most compelling finding targets individuals who believe they are making a healthier choice by switching from traditional cigarettes to e-cigarettes. The study reveals this group is walking into a "harm reduction trap."
Former smokers who switched to vaping faced more than double (2.52 times higher) the heart attack risk compared to those who quit tobacco and nicotine entirely. Their stroke risk was also 1.73 times higher. Dr. Prashant Kumar Singh, co-lead author and nodal officer of the WHO FCTC Knowledge Hub at ICMR-NICPR, directly challenged the tobacco industry's narrative. "They tell smokers, don't quit, just switch. But switching means continued nicotine addiction, continued cardiovascular damage, and continued industry profits," he explained.
Why the Misconception? The Nicotine Truth
Experts involved in the study clarified that the core misconception stems from the absence of smoke. Dr. Vijay Natarajan, Chief of Cardiac Surgery at Poona Hospital, stated, "The most dangerous component in cigarettes is nicotine which is found in equal measure in e-cigarettes."
Dr. Ruchika Gupta, the study's lead scientist at ICMR-NICPR, detailed nicotine's destructive cascade: it raises heart rate and blood pressure, damages blood vessel linings, promotes clotting, and accelerates artery plaque buildup. "These effects occur whether nicotine comes from a conventional cigarette or an e-cigarette," she emphasized. Dr. Shalini Singh, Director of ICMR-NICPR and senior author, stated the research definitively "shatters the myth that e-cigarettes are harmless alternatives."
The Path Forward: Enforcement and Genuine Cessation
The study authors assert that their findings strongly validate India's 2019 decision to ban e-cigarettes. The challenge now lies in robust implementation—strict enforcement, protecting youth, and scaling up access to proven, non-nicotine cessation methods.
"When tobacco users want to quit but are told e-cigarettes are an option, we are failing them," said Dr. Prashant Kumar Singh. He urged a massive scale-up of behavioural support, counselling, and non-nicotine pharmacological options. The ultimate message from this vast ICMR study is unambiguous: for cardiovascular health, quitting all forms of tobacco and nicotine, with proper medical support, remains the only safe way out.
