{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:21:04Z","timestamp":1793830864602,"version":"4.6.1"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Cordoba"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Toxics"],"abstract":"<jats:p>Objective: To synthesize the current evidence on the cardiovascular effects of electronic cigarettes (ECs) in young adults (18\u201330 years), distinguishing between acute and chronic exposure, and comparing their effects to conventional tobacco (CT) use. Methods: A systematic review and meta-analysis (PROSPERO: CRD420251072847) was conducted following PRISMA guidelines. A total of 21 studies (12 RCTs, 8 case\u2013control, 1 cohort) involving 17241 participants were included. Results: Acute EC use, particularly with nicotine, significantly increased systolic blood pressure (SBP: MD = 3.14 mmHg, 95% CI: 0.76 to 5.52), diastolic blood pressure (DBP: MD = 2.05 mmHg, 95% CI: 0.85 to 3.25), and heart rate (HR: MD = 4.23 bpm, 95% CI: 2.10 to 6.37), with effects most pronounced at 0 min post-exposure and dissipating within 1 h. Chronic EC use was associated with reduced endothelium-dependent vasodilation and early atherosclerotic changes. Nicotine-free ECs induced fewer cardiovascular alterations. Comparisons with CT revealed less severe cardiovascular damage with ECs, though still significant when compared to non-smokers. Conclusion: Nicotine-containing EC use in young individuals is associated with modest, predominantly acute and dose-dependent, cardiovascular effects, including transient increases in BP and HR. While initially less harmful than CT, the evidence is largely from cross-sectional studies and acute use, so ECs cannot be considered safe and their use warrants caution in youth.<\/jats:p>","DOI":"10.3390\/toxics13100831","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T14:16:29Z","timestamp":1759241789000},"page":"831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Time- and Dose-Dependent Cardiovascular Effects of Nicotine-Containing Electronic Cigarettes in Young Adults: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Carmen","family":"Ranchal-Lavela","sequence":"first","affiliation":[{"name":"Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4922-8550","authenticated-orcid":false,"given":"David","family":"Casanova-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8655-8878","authenticated-orcid":false,"given":"Antonio","family":"Ranchal-Sanchez","sequence":"additional","affiliation":[{"name":"Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain"},{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2473-0660","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9 De La","family":"Torre-Aguilar","sequence":"additional","affiliation":[{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0198-2793","authenticated-orcid":false,"given":"Jose Manuel","family":"Jurado-Castro","sequence":"additional","affiliation":[{"name":"Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain"},{"name":"CIBER Fisiopatolog\u00eda de la Obesidad y Nutrici\u00f3n (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Ciencias de la Actividad F\u00edsica y El Deporte, Escuela Universitaria de Osuna (Centro Adscrito a la Universidad de Sevilla), 41640 Osuna, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.amjmed.2015.01.033","article-title":"Electronic Cigarettes\u2014A Narrative Review for Clinicians","volume":"128","author":"Payne","year":"2015","journal-title":"Am. J. Med."},{"key":"ref_2","unstructured":"Direcci\u00f3n General de Salud P\u00fablica (2024). Informe Sobre Los Cigarrillos Electr\u00f3nicos: Situaci\u00f3n Actual, Evidencia Disponible y Regulaci\u00f3n, Ministerio de Sanidad."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Upadhyay, S., Rahman, M., Johanson, G., Palmberg, L., and Ganguly, K. (2023). Heated Tobacco Products: Insights into Composition and Toxicity. Toxics, 11.","DOI":"10.3390\/toxics11080667"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6079","DOI":"10.1158\/0008-5472.CAN-19-2997","article-title":"E-Cigarettes: Unstandardized, Under-Regulated, Understudied, and Unknown Health and Cancer Risks","volume":"79","author":"Hawk","year":"2019","journal-title":"Cancer Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1056\/NEJMoa1808779","article-title":"A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy","volume":"380","author":"Hajek","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.pecs.2006.01.001","article-title":"Smoke Generation inside a Burning Cigarette: Modifying Combustion to Develop Cigarettes That May Be Less Hazardous to Health","volume":"32","author":"Baker","year":"2006","journal-title":"Prog. Energy Combust. Sci."},{"key":"ref_7","first-page":"17","article-title":"Respiratory impact of electronic cigarettes and \u201clow-risk\u201d tobacco","volume":"71","author":"Zabert","year":"2019","journal-title":"Rev. Investig. Clin. Organo Hosp. Enfermedades Nutr."},{"key":"ref_8","unstructured":"Ministerio de Sanidad (2023). Encuesta Sobre Uso de Drogas en Ense\u00f1anzas Secundarias en Espa\u00f1a, ESTUDES 2023, Ministerio de Sanidad."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100506","DOI":"10.1016\/j.puhip.2024.100506","article-title":"The Global Prevalence of E-Cigarettes in Youth: A Comprehensive Systematic Review and Meta-Analysis","volume":"7","author":"Salari","year":"2024","journal-title":"Public Health Pract. Oxf. Engl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/15563650.2022.2160342","article-title":"E-Cigarette or Vaping-Associated Lung Injury (EVALI): A Review of International Case Reports from Outside the United States of America","volume":"61","author":"Sund","year":"2023","journal-title":"Clin. Toxicol. Phila. Pa"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jenvman.2019.01.030","article-title":"Main and Side Stream Effects of Electronic Cigarettes","volume":"238","author":"Papaefstathiou","year":"2019","journal-title":"J. Environ. Manag."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101748","DOI":"10.1016\/j.cpcardiol.2023.101748","article-title":"Association of Electronic Cigarette Exposure on Cardiovascular Health: A Systematic Review and Meta-Analysis","volume":"48","author":"Siddiqi","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1136\/emermed-2020-209567","article-title":"Population, Intervention, Comparison, Outcomes and Study (PICOS) Design as a Framework to Formulate Eligibility Criteria in Systematic Reviews","volume":"37","author":"Janati","year":"2020","journal-title":"Emerg. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A Web and Mobile App for Systematic Reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/001316446002000104","article-title":"A Coefficient of Agreement for Nominal Scales","volume":"20","author":"Cohen","year":"1960","journal-title":"Educ. Psychol. Meas."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Landis, J.R., and Koch, G.G. (1977). The Measurement of Observer Agreement for Categorical Data. Biometrics, 33.","DOI":"10.2307\/2529310"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying Heterogeneity in a Meta-Analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10456-023-09903-7","article-title":"Evidence of Premature Vascular Dysfunction in Young Adults Who Regularly Use E-Cigarettes and the Impact of Usage Length","volume":"27","author":"Matheson","year":"2024","journal-title":"Angiogenesis"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.atherosclerosis.2021.03.021","article-title":"Atherosclerosis Inflammation and Burden in Young Adult Smokers and Vapers Measured by PET\/MR","volume":"325","author":"Sahota","year":"2021","journal-title":"Atherosclerosis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/ntr\/ntac170","article-title":"Sex Differences in the Association of E-Cigarette and Cigarette Use and Dual Use With Self-Reported Hypertension Incidence in US Adults","volume":"25","author":"Shi","year":"2023","journal-title":"Nicotine Tob. Res. Off. J. Soc. Res. Nicotine Tob."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2641","DOI":"10.1161\/HYPERTENSIONAHA.123.21684","article-title":"Sex Differences in Oxidative Stress-Mediated Reductions in Microvascular Endothelial Function in Young Adult e-Cigarette Users","volume":"80","author":"Halstead","year":"2023","journal-title":"Hypertension"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e13393","DOI":"10.14814\/phy2.13393","article-title":"Activation of the \u201cSplenocardiac Axis\u201d by Electronic and Tobacco Cigarettes in Otherwise Healthy Young Adults","volume":"5","author":"Boas","year":"2017","journal-title":"Physiol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1161\/ATVBAHA.123.319172","article-title":"Chronic Electronic Cigarette Use and Atherosclerosis Risk in Young People: A Cross-Sectional Study-Brief Report","volume":"43","author":"Kelesidis","year":"2023","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1001\/jamacardio.2016.5303","article-title":"Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk","volume":"2","author":"Moheimani","year":"2017","journal-title":"JAMA Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"H821","DOI":"10.1152\/ajpheart.00057.2023","article-title":"Electronic Cigarettes Prolong Ventricular Repolarization in People Who Smoke Tobacco Cigarettes: Implications for Harm Reduction","volume":"324","author":"Ruedisueli","year":"2023","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Youn, J.Y., Middlekauff, H.R., Reudiseuli, I., Huang, K., and Cai, H. (2023). Endothelial Damage in Young Adult E-Cigarette Users. Redox Biol., 62.","DOI":"10.1016\/j.redox.2023.102688"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s12012-019-09516-x","article-title":"Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways","volume":"19","author":"Antoniewicz","year":"2019","journal-title":"Cardiovasc. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"H262","DOI":"10.1152\/ajpheart.00192.2020","article-title":"Acute and Chronic Sympathomimetic Effects of E-Cigarette and Tobacco Cigarette Smoking: Role of Nicotine and Non-Nicotine Constituents","volume":"319","author":"Arastoo","year":"2020","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"H144","DOI":"10.1152\/ajpheart.00628.2020","article-title":"Acute E-Cig Inhalation Impacts Vascular Health: A Study in Smoking Na\u00efve Subjects","volume":"320","author":"Chatterjee","year":"2021","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10286-015-0304-z","article-title":"Acute Inhalation of Vaporized Nicotine Increases Arterial Pressure in Young Non-Smokers: A Pilot Study","volume":"25","author":"Cooke","year":"2015","journal-title":"Clin. Auton. Res. Off. J. Clin. Auton. Res. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/1440-1681.13180","article-title":"Vascular Effects of a Single Bout of Electronic Cigarette Use","volume":"47","author":"Cossio","year":"2020","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"H248","DOI":"10.1152\/ajpheart.00448.2020","article-title":"Acute Effects of Electronic Cigarettes on Arterial Pressure and Peripheral Sympathetic Activity in Young Nonsmokers","volume":"320","author":"Gonzalez","year":"2021","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"H547","DOI":"10.1152\/ajpheart.00307.2020","article-title":"Differential Effects of Tobacco Cigarettes and Electronic Cigarettes on Endothelial Function in Healthy Young People","volume":"319","author":"Haptonstall","year":"2020","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1001\/jamapediatrics.2021.2351","article-title":"Association of 1 Vaping Session With Cellular Oxidative Stress in Otherwise Healthy Young People With No History of Smoking or Vaping: A Randomized Clinical Crossover Trial","volume":"175","author":"Kelesidis","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s12012-023-09802-9","article-title":"Electronic Cigarette Vaping with Nicotine Causes Increased Thrombogenicity and Impaired Microvascular Function in Healthy Volunteers: A Randomised Clinical Trial","volume":"23","author":"Lyytinen","year":"2023","journal-title":"Cardiovasc. Toxicol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jhsa.2017.12.003","article-title":"The Effect of Electronic Cigarettes on Hand Microcirculation","volume":"43","author":"Pywell","year":"2018","journal-title":"J. Hand Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e15412","DOI":"10.14814\/phy2.15412","article-title":"Neural-Hematopoietic-Inflammatory Axis in Nonsmokers, Electronic Cigarette Users, and Tobacco Smokers","volume":"10","author":"Ruedisueli","year":"2022","journal-title":"Physiol. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sumartiningsih, S., Lin, H.-F., and Lin, J.-C. (2019). Cigarette Smoking Blunts Exercise-Induced Heart Rate Response among Young Adult Male Smokers. Int. J. Environ. Res. Public. Health, 16.","DOI":"10.3390\/ijerph16061032"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.15585\/mmwr.mm685152e2","article-title":"Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-Cigarette, or Vaping, Product Use\u2013Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge\u2014United States, December 2019","volume":"68","author":"Evans","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e200756","DOI":"10.1001\/jamapediatrics.2020.0756","article-title":"Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019","volume":"174","author":"Adkins","year":"2020","journal-title":"JAMA Pediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"114187","DOI":"10.1016\/j.socscimed.2021.114187","article-title":"Comparing the Regulation and Incentivization of E-Cigarettes across 97 Countries","volume":"291","author":"Campus","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2015893","DOI":"10.1001\/jamanetworkopen.2020.15893","article-title":"Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Progression or Reduction Among Young Adults","volume":"3","author":"Pearson","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1037\/0033-3204.38.4.443","article-title":"Stages of Change","volume":"38","author":"Prochaska","year":"2001","journal-title":"Psychother. Theory Res. Pract. Train."},{"key":"ref_46","unstructured":"(2025, July 29). Ministerio de la Presidencia y Para las Administraciones Territoriales Real Decreto 579\/2017, de 9 de Junio, por el que se Regulan Determinados Aspectos Relativos a la Fabricaci\u00f3n, Presentaci\u00f3n y Comercializaci\u00f3n de los Productos del Tabaco y los Productos Relacionados. Available online: https:\/\/www.boe.es\/eli\/es\/rd\/2017\/06\/09\/579\/con."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1021\/acs.chemrestox.3c00251","article-title":"Enhancement of Benzene Emissions in Special Combinations of Electronic Nicotine Delivery System Liquid Mixtures","volume":"37","author":"Hayeck","year":"2024","journal-title":"Chem. Res. Toxicol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12931-022-02142-2","article-title":"Propylene Glycol, a Component of Electronic Cigarette Liquid, Damages Epithelial Cells in Human Small Airways","volume":"23","author":"Komura","year":"2022","journal-title":"Respir. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sassano, M.F., Davis, E.S., Keating, J.E., Zorn, B.T., Kochar, T.K., Wolfgang, M.C., Glish, G.L., and Tarran, R. (2018). Evaluation of E-Liquid Toxicity Using an Open-Source High-Throughput Screening Assay. PLoS Biol., 16.","DOI":"10.1371\/journal.pbio.2003904"}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/10\/831\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T04:27:54Z","timestamp":1759379274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/10\/831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["toxics13100831"],"URL":"https:\/\/doi.org\/10.3390\/toxics13100831","relation":{},"ISSN":["2305-6304"],"issn-type":[{"value":"2305-6304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}