More people in their 20s and 30s are experiencing heart disease — cardiologists warn vaping may be to blame

• Three cardiologists told Insider that vaping might be a factor in rising heart diseases cases among young people. 
• Vaping delivers substances linked to heart damage to the body, and can make exercising more challenging.
• As many as 2.5 million teens were vaping in 2022, and researchers are still studying the behavior's long-term effects.

Millions of young Americans are vaping, and their hearts could be praying the price.

Heart disease, an umbrella term for a variety of heart issues, is becoming more prevalent among young people. Heart attacks among people 25 to 44 increased by 30% since 2020, a worrying trend as most heart attacks don't occur until people reach their 60s to 70s. 

Though researchers are still studying why rates are rising, three cardiologists told Insider the rise of vaping among young people might be a factor. The number of middle and high school students using e-cigarettes increased by 900% from 2011 to 2015, per the Centers for Disease Control and Prevention, and as many as 2.5 million teens are vaping as of 2022. 

Cardiologists broke down the ways vaping might pose a heart health risk similar to that of combustible cigarettes, but acknowledged more research is needed before establishing a direct cause.

"Electronic cigarettes and vaping are particularly prevalent among younger people, and that is one health behavior that really could stand to be improved," Dr. Nilay Shah, a cardiologist at Northwestern University, told Insider when asked why heart disease cases might be on the rise among young people.

Vaping can stress the heart in similar ways as traditional cigarettes

Heart doctors have cautioned against smoking traditional cigarettes for decades, as tobacco use is one of the biggest risk factors for heart disease.

Companies first marketed vapes and e-cigarettes as a way to help smokers wean off cigarettes, which deliver burned tar and smoke into the body. Vaping, on the other hand, heats up a liquid mixture that delivers substances like nicotine or cannabis — plus the chemicals in the liquid mix — to the body.

But any exposure to nicotine — whether it be through vapes or cigarettes — raises your blood pressure and can lead to heart disease, Dr. Jim Liu, a cardiologist at The Ohio State University Wexner Medical Center, told Insider.

Liu said the rising rates of heart disease among young people could be tied to e-cigarette and vaping use, as well as illicit drug use. Many vapes also contain cannabis, which is newly legal in many states, but doctors told Insider more research is needed to determine its heart health risks. 

Aside from nicotine exposure, vaping, particularly when started young, could have other adverse effects on the heart, said Rose Marie Robertson, the American Heart Association's deputy chief science and medical officer.

For one, inhaling chemicals and oily substances found in vapes causes inflammation of the lungs, which can lead to shortness of breath. Robertson said getting easily winded discourages young people from exercising, which is crucial to warding off heart disease. 

And though vaping nicotine delivers fewer toxic substances into the body compared to combustible cigarettes, the chemicals it does deliver — like acrolein and formaldehyde — have known links to heart damage, per Robertson.

Flavored vapes, popular among young people, might be even worse, she added. Many e-cigarettes makers use artificial flavors on the FDA's Generally Recognized as Safe (GRAS) list, but the list only contains chemicals that are safe when ingested through food, not when inhaled.

"So, for example, water is very safe if you drink it, but if you pour it into the lungs, not so good," she said.

Establishing a potential link between vaping and heart disease in young people will take more time

Though cardiologists said they fear vaping could be a significant factor behind the rise of heart disease among young people, researchers have not established a direct link — partly due to the challenges of studying this topic. 

Most studies that examine heart health and e-cigarette use use adult test subjects who have smoked or also smoke traditional cigarettes, making it hard to decipher vaping's unique risk, Robertson said.

Vaping's risk for heart disease might be unique in young people who have never smoked traditional cigarettes, Robertson said. But researchers cannot give a group of teenagers vapes and measure their long-term health against a control group, since giving minors a potentially harmful substance is unethical. 

The next best way to study these effects is through observing the health of vape users, traditional smokers, and non-smokers over the course of at least several years. According to Robertson, these types of studies are expensive and time consuming, hindering the release of data.

Still, Robertson said early studies do show vaping's unique harm to heart health. A 2021 study in animals found vaping impairs blood vessels and the heart's ability to maintain blood pressure.

"Some of the things that we know have adverse to the heart can still be measured in people who vape," Robertson said.

(Altria, the parent company of tobacco firms like Philip Morris USA and U.S. Smokeless Tobacco Company, did not respond to Insider's request for comment on this article.)