Nicotine Vaping Linked to Lower Vascular Function in Young Adults

Young adults who vape nicotine daily but have never smoked cigarettes showed lower vascular function and cardiorespiratory fitness than peers who use neither product, according to a cross-sectional study published in JAMA Cardiology. For pharmacists who counsel adults on tobacco and nicotine use, the findings add physiological data to the question of whether vaping carries cardiovascular consequences in people otherwise considered low risk.¹

The investigators noted that rising nicotine vape use among young adults who have never smoked combustible tobacco raises concerns about early cardiovascular and respiratory effects in this population. National data reflect that trend: according to the CDC's National Center for Health Statistics (NCHS), e-cigarette use among US adults rose from 4.5% in 2019 to 6.5% in 2023, and adults aged 21 to 24 years had the highest use in 2023, at 15.5%.^1,2

Study Design and Population

The single-center, laboratory-based study was conducted between July 2023 and April 2025 among young adults without known cardiovascular disease or major risk factors. Based on self-report and verification of smoking status, participants were stratified into 3 groups: adults who exclusively used nicotine vapes, adults who used combustible cigarettes, and tobacco- and nicotine vape–naive individuals.¹

Of 58 participants (mean [SD] age, 26 [7] years; 52% female), 17 exclusively used nicotine vapes, 19 used combustible cigarettes, and 22 were naive to both. Primary outcomes were vascular function, measured by flow-mediated dilation (FMD) and carotid artery reactivity (CAR), and cardiorespiratory fitness, assessed through ventilatory, metabolic, and cardiac responses during maximal cardiopulmonary exercise testing. Lung function and physical activity levels did not differ significantly across groups.¹

Vascular Function Lower in Both Nicotine Groups

Mean FMD was 5.5% (SD, 3.4%) among adults who vaped and 4.4% (SD, 2.9%) among adults who smoked, compared with 8.3% (SD, 3.4%) in the naive group. CAR followed a similar pattern, at 0.6% (SD, 5.3%) for adults who vaped and −1.4% (SD, 5.3%) for adults who smoked versus 4.7% (SD, 3.2%) for naive participants. The authors reported that the FMD impairments seen with vaping were similar to those observed in adults who smoked combustible cigarettes.¹

Lower Peak Oxygen Uptake Among Adults Who Vape

Peak oxygen uptake was lower in adults who used nicotine vapes than in tobacco- and nicotine-vape-naive individuals, but it did not differ significantly between the combustible cigarette and naive groups. Minute ventilation and cardiac output were lower in both nicotine use groups.¹

The authors concluded that regular daily vape use in young adults who have never smoked was associated with lower vascular function and cardiorespiratory fitness, and they called for longitudinal studies to determine the long-term clinical implications. Because the study was small and cross-sectional, it cannot show that vaping caused the differences observed.¹

Counseling Considerations Amid a Shifting Regulatory Landscape

The findings arrive as the legal market for vaping products expands. In May 2026, the FDA authorized 4 Glas electronic nicotine delivery systems (ENDS) through the premarket tobacco product application pathway, including mango- and blueberry-flavored products that became the first authorized nontobacco, nonmenthol-flavored vaping products in the US. Marketing of the products is limited to adults aged 21 years and older.³

At the time of that authorization, the FDA emphasized that there is no safe tobacco product and that people who do not use tobacco should not start. The new data support pharmacists reinforcing that message with young adults who may view vaping as harmless, particularly those who have never smoked. For patients who want to quit, Pharmacy Times previously reported that FDA-approved cessation options, including varenicline, bupropion, and nicotine replacement therapy, should be prioritized over ENDS.³

REFERENCES

1. Boidin M, Degens H, Junejo RT. Vascular function and cardiorespiratory fitness in adults who use nicotine vapes. JAMA Cardiol. Published online October 21, 2026. Accessed October 30, 2026. doi:10.1001/jamacardio.2026.4626

2. Vahratian A, Briones EM, Jamal A, Marynak KL. Electronic cigarette use among adults in the United States, 2019–2023. NCHS Data Brief, no 524. National Center for Health Statistics; 2025. doi:10.15620/cdc/174583

3. Halpern L. FDA authorizes first-ever fruit-flavored ENDS products, marking major policy shift. Pharmacy Times. May 6, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/fda-authorizes-first-ever-fruit-flavored-ends-products-marking-major-policy-shift