Evidence map›Paper›PMID 41731465›Full record

SynthesisBMC public health2026

Electronic cigarettes and cardiovascular outcomes: a systematic review and meta-analysis of Major Adverse Cardiovascular Events (MACE).

Suraa N Al-Rubaye, Mohammedsadeq A Shweliya, Mohamed Fawzi Hemida, Mohammad Bdair, Amr M Abou Elezz, Mohamed Ashraf Shehab, Yara Abukhaled, Abdulrahman Raad Abdulkareem Al-Waeli, Al-Tuaama Abdullah Zeyad Hameed, Abbas F Abdul Hussein and 2 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Suraa N Al-RubayeImam Al-Sadiq Teaching Hospital, Coronary Care Unit, Hillah, Babylon, Iraq.
Mohammedsadeq A ShweliyaUniversity of Baghdad College of Medicine, Baghdad, Iraq.
Mohamed Fawzi HemidaFaculty of Medicine, Alexandria University, Alexandria, Egypt.
Mohammad BdairDepartment of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Amr M Abou ElezzFaculty of Medicine, Tanta University, Tanta, Egypt.
Mohamed Ashraf ShehabFaculty of Medicine, Menoufia University, Menoufia, Egypt.
Yara AbukhaledThe University of Tennessee Health and Science Center, Memphis, TN, USA.
Abdulrahman Raad Abdulkareem Al-WaeliDepartment of Internal Medicine, Al-Karkh General Hospital, Baghdad, Iraq.
Al-Tuaama Abdullah Zeyad HameedPrivolzhsky Research Medical University, Nizhny Novgorod, Russia.
Abbas F Abdul HusseinBabylon University, College of Medicine, Hilla, Babylon, Iraq.
Khadeeja Ali HamzahBaghdad university Alkindy College of Medicine, Baghdad, Iraq.
Mustafa Al-JarshawiFaculty of Medicine & Health Sciences, Keele Cardiovascular Research Group, Keele University, Newcastle-under-Lyme, UK. mustafa.al-jarshawi@manchester.ac.uk.ORCID http://orcid.org/0000-0002-4600-2701

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElectronic Nicotine Delivery Systems (ENDS), including e-cigarettes, are increasingly used worldwide, yet their association with major adverse cardiovascular outcomes remains inconclusive.

methodsWe conducted a systematic review and meta-analysis (PROSPERO: CRD420251026677) in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Scopus were searched up to May 10, 2025. Eligible studies included adolescents (13–18 years) and adults (≥ 19 years) using ENDS, reporting outcomes on any of the following: non-fatal myocardial infarction (MI), stroke, coronary artery disease (CAD), or cardiovascular mortality. The pooled odds ratios (ORs) were estimated using random-effects models and were considered the primary effect measures for assessing cardiovascular risk across exposure groups. Pooled outcome proportions were reported as secondary measures, reflecting the prevalence of outcomes within the ENDS-exposed population.

resultsTwenty-six studies, comprising over 900,000 ENDS users, were analyzed. The meta-analyses showed significantly higher pooled odds of coronary heart disease (OR = 1.19, p < 0.0001), major adverse cardiovascular events (MACE) (OR = 1.57, p < 0.0001), and stroke (OR = 1.62, p < 0.01). The greatest risk was observed among dual users (OR = 2.21, p < 0.0001.), indicating additive cardiovascular harm associated with combined use. All outcomes demonstrated substantial heterogeneity between-study variability.

conclusionENDS use is associated with potential cardiovascular harm, particularly regarding stroke and non-fatal MI; however, the overall findings are limited by substantial heterogeneity. Associations with CAD and mortality remain inconclusive due to data limitations. High-quality longitudinal studies are needed to clarify the long-term cardiovascular risks of ENDS, which could ultimately guide public health policies and initiatives.

Indexed as

Cardiovascular DiseasesElectronic Nicotine Delivery SystemsHumansCardiovascular diseaseCoronary artery diseaseE-cigarettesElectronic nicotine delivery systemsENDsMACEMeta-analysisMyocardial infarctionStrokeVapeVaping

Identifiers

PMID41731465
PMCPMC12927215

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.