February is American Heart Month, a time when Americans are urged to take steps to reduce their risks for heart disease. The heart disease risks associated with smoking are well known, but a growing body of evidence also adds weight to calls for more research on the potential connection between vaping and heart disease. Some studies have suggested that the use of e-cigarettes has been found to negatively impact blood vessels, heart rate, blood pressure, and blood oxygen levels, all of which can increase the risk of heart disease.

In a 2019 study, researchers reviewed responses from 96,467 people who participated in the Centers for Disease Control and Prevention’s National Health Interview Survey in 2014, 2016, and 2017 (the 2015 survey included no questions about e-cigarettes). The researchers found that, after controlling for certain known cardiovascular risk factors such as body mass index and cholesterol level, e-cigarette users were 34% more likely to have a heart attack and 25% more likely to have coronary artery disease than non-users.

Researchers reviewing National Institutes of Health data for a 2024 study looked at associations between e-cigarette use and new diagnoses of heart failure. Their research suggested that among the 175,667 study participants, those who had used e-cigarettes at any point were 19% more likely to develop heart failure compared with those who had never used e-cigarettes.

A 2022 review of available research on e-cigarettes found there is evidence to suggest inhaling any one of several components of e-cigarette vapor can promote heart disease. These include nicotine; glycerol and propylene glycerol; ingredients found in some flavorings, such as vanillin, cinnamaldehyde, eugenol, and acetylpyridine; and metal particles that can be absorbed into users’ bloodstreams after they are inhaled. “Studies comparing the [cardiovascular disease] effect of e-cigarettes vs. conventional cigarettes and especially those who use e-cigarettes to attempt to quit conventional cigarettes are urgently needed,” the authors wrote.

How Many People Use E-Cigarettes?

While adult smoking rates have generally been decreasing across the U.S., adult vaping rates have been increasing. The 2024 America’s Health Rankings report, released in January by the United Health Foundation, finds that 12.1% of U.S. adults smoke, a 43% decrease from 21.2% in 2011, and that 7.7% of adults use e-cigarettes, a 67% increase from 4.6% in 2017. Vaping is more prevalent in Arkansas than it is nationally, with 10.6% of Arkansas adults using e-cigarettes, according to the report.

Vaping has lately decreased among U.S. teens, with 7.8% of U.S. high school students reporting being current users of e-cigarettes in 2024, down from 10% in 2023, according to the Centers for Disease Control and Prevention. In Arkansas, 17.5% of public high school seniors reported in 2023 that they had vaped in the past 30 days, down from 20.6% in 2022. Despite recent decreases, however, youth vaping rates in the U.S. have exceeded youth smoking rates every year since 2014. E-cigarettes continue to be young people’s No. 1 entry point to what for many will become a lifetime of nicotine addiction.

Policy Options

The American Lung Association’s 2025 State of Tobacco Control report, released in January, gives Arkansas a grade of “C” in the category of smokefree air. The report notes that although Arkansas prohibits smoking in most workplaces and public spaces under the Arkansas Clean Indoor Air Act of 2006, it only bans vaping in K-12 schools and some colleges. There have been various attempts over the years to expand the Clean Indoor Air Act to include e-cigarettes, but to date those attempts have not succeeded.

The report also faults Arkansas for a state law that preempts local governments from regulating the sale and taxation of tobacco products and e-cigarettes. It also gives Arkansas an “F” in the category of tobacco taxes, in part because the state does not have an e-cigarette tax that is comparable to its tax on tobacco products.

If policymakers wish to reduce e-cigarette use in Arkansas, there are many options available to them, including:

• End the preemption of local governments’ ability to regulate e-cigarettes.
• Levy an excise tax on e-cigarettes that is no less than the tax on tobacco products and is based on nicotine amounts.
• Include e-cigarettes in the Arkansas Clean Indoor Air Act.
• Ban all flavored vaping liquids.
• Increase enforcement efforts to ensure retailers are complying with age restrictions for tobacco product purchases, including e-cigarettes.
• Prohibit e-cigarette advertising that targets youth.

The ACHI Health Policy Board has adopted the following position statement: “The ACHI Health Policy Board’s position is that vaping products are devices capable of delivering addictive nicotine to users, and they should be regulated in a manner similar to other tobacco products. If available at all, vaping products should be only available via prescription as a means of harm reduction for individuals who currently use tobacco and have no plan to quit using tobacco.”

See more on policy options for addressing e-cigarette use, and additional information about vaping, on our topic page.