An Update on Biological and Clinical Associations between E-Cigarettes and Myocardial Infarction

Recent biological and epidemiologic findings, as briefly reviewed here, would lead us to conclude that significant associations may exist between e-cigarette use and myocardial infarction, which appear to be dose-dependent and potentially magnified by concomitant use of “conventional” combustible cigarettes. Although no prospective studies have been published to date that can provide stronger epidemiologic evidence on this matter, the results of some biological investigations seem to support this association, whereby a prothrombotic phenotype (especially characterized by enhanced platelet activation, and possibly increased adhesion and aggregation) may develop after exposure to nicotine-containing e-cigarette vapors. Although it is premature to currently draw definitive conclusions, also noting that the harmful effects of e-cigarettes appear globally lower than those causes by conventional combustible cigarettes, we still raise well-founded doubts that recreational use of e-cigarette is safe, so that their usage in nonsmokers should probably continue to be discouraged.