Young adults using nicotine electronic cigarettes face blood vessel damage and reduced physical fitness matching tobacco smokers, a JAMA Network study has found.
The research revealed that daily vaping causes significant declines in respiratory capacity and vascular dilation even in young people who have never smoked conventional cigarettes and have no underlying cardiovascular risk factors.
Published on October 21 by JAMA Network, a consortium of peer-reviewed journals produced by the American Medical Association, the investigation tracked 58 young adults between July 2023 and April 2025. None of the participants had any diagnosed cardiovascular conditions or significant risk factors before entering the trial.
The cohort was divided into three distinct groups: 17 participants who used only nicotine vapes every day, 19 individuals who smoked only traditional tobacco cigarettes, and a control group of 22 people who used neither product.
Researchers evaluated vascular health using flow-mediated dilation, an ultrasound measurement of how arteries widen when blood flow increases, and carotid artery reactivity, which checks blood vessel responses in the neck. They also tested cardiorespiratory fitness by measuring ventilatory, metabolic and heart responses during maximal cardiopulmonary exercise sessions, alongside physical activity assessments to record how the body responds to strenuous exertion.
The findings demonstrated reduced carotid artery reactivity and lower maximal oxygen consumption among daily nicotine vape users compared with peers who had never consumed tobacco or electronic cigarettes. The authors noted that further research is essential to understand the long-term clinical consequences because modern vaping remains a relatively recent phenomenon.
Cardiovascular risks and biological damage
Medical specialists warn that the physical consequences of electronic cigarettes extend far beyond temporary respiratory irritation. Dr Herik Oliveira, a vascular surgeon at the Brazilian Society of Angiology and Vascular Surgery, explained that impaired cardiorespiratory fitness dramatically raises the lifetime risk of cardiovascular emergencies.
Oliveira highlighted that vaping promotes arterial hypertension, acute myocardial infarction, strokes, peripheral arterial disease and aneurysms, emphasising that both electronic and conventional cigarettes cause severe harm.
Nicotine causes an immediate surge in blood pressure and heart rate while placing acute physical stress on blood vessels, particularly the coronary arteries supplying the heart muscle, Oliveira explained. He noted that this strain encourages vessel inflammation and blood clot formation, while also weakening arterial and venous walls through inflammatory processes and changes in blood coagulation.
Vascular damage often develops silently in young adults without producing obvious symptoms, Oliveira said. He cautioned that regular routine medical checkups frequently fail to detect these changes because young bodies can adapt to nicotine damage for years before clinical illness appears.
Stroke trends and misconceptions among youth
The physical impact of nicotine consumption across younger demographics has also surfaced in neurological research. A study published in September in Neurology, the official scientific journal of the American Academy of Neurology, identified smoking as a major contributor to rising stroke rates among people aged 20 to 54 between 1993 and 2020.
The findings from JAMA Network demonstrate that electronic cigarettes produce vascular harm very similar to conventional tobacco, which is particularly concerning given the surging popularity of vapes among teenagers and young adults.
Oliveira noted that many young consumers mistakenly believe electronic cigarettes are harmless because of widespread misinformation and social pressure. He explained that many people believe vapes emit only water vapour and represent an innocent alternative to cigarettes, when in reality they deliver potent toxins.
Peer influence, social media marketing and party culture have turned vaping into a widespread social trend, Oliveira said. He pointed out that manufacturers produce liquids and aerosols with sweet, candy-like flavours that conceal the harsh taste of nicotine, while sleek, compact device designs allow young people to carry and conceal them easily at schools and social events.
Vaping prevalence and bans in Brazil
The findings arrive amid growing concerns over youth vaping across Latin America. In Brazil, the sale, importation and advertising of electronic cigarettes have been illegal since 2009 under regulations enforced by the National Health Surveillance Agency, known as Anvisa.
Despite that long-standing prohibition, experimentation has climbed sharply among secondary school pupils. Data from the 2024 National School Health Survey, conducted by the Brazilian Institute of Geography and Statistics, revealed that 29.6 per cent of students aged between 13 and 17 have tried an electronic cigarette.
That figure represents a substantial increase from the 16.8 per cent recorded in the previous national survey in 2019, highlighting how widely illicit vaping devices have penetrated youth culture. In response to rising use, Anvisa approved a unanimous resolution in 2024 that reinforced the nationwide ban on the sale, manufacture, importation and promotion of all electronic smoking devices.
Health authorities stress that even nicotine-free electronic cigarettes carry severe health hazards. Devices that do not contain nicotine still release heavy metals, chemical flavorings and chemical toxins that cause oxidative stress, cellular inflammation and endothelial dysfunction in blood vessel linings.
Medical support and quitting strategies
Overcoming e-cigarette dependency requires structured medical intervention, according to Oliveira, who explained that successful cessation demands a multidisciplinary approach involving psychologists, pulmonologists and, for younger patients, paediatricians. He noted that patients facing severe chemical addiction may also require nicotine replacement therapy.
Oliveira emphasised that patients must alter their daily routines and habits to eliminate triggers, which starts with physically throwing away all vaping devices. He recommended regular physical exercise to stimulate natural endorphins and reduce anxiety, alongside higher daily water consumption to support recovery.
In Brazil, smokers and vape users can access free addiction treatment through the National Tobacco Control Program, operated across the country by the Unified Health System, known as SUS. Anyone seeking help can enrol by visiting a local Basic Health Unit with an original photo identification card and registering for cessation support.
Demand for smoking cessation resources remains substantial, with more than 2.5 million Brazilians having sought formal medical treatment to quit smoking. Medical organisations also promote quit strategies annually around World No Tobacco Day, while international governments pursue stricter anti-smoking measures, including legislation in the United Kingdom banning tobacco sales to anyone born in 2009 or later.
