The hidden epidemic of vaping

The global surge in electronic nicotine delivery systems (ENDS) has reshaped tobacco control debates, often under the guise of harm reduction. However, a 2025 BMJ Open umbrella review integrating 69 systematic reviews exposes a starkly different reality: ENDS are far from benign.

Synthesizing data from over 5,000 publications, the review reveals significant associations between ENDS use and cardiovascular and respiratory diseases, mental health disorders, and oral pathology. Nicotine inhalation consistently elevates heart rate, systolic and diastolic blood pressure, and disrupts endothelial and platelet function, collectively heightening cardiovascular risk. Respiratory effects include reduced lung function and an increased likelihood of asthma and chronic obstructive pulmonary disease.

ENDS use among adolescents was notably correlated with depression, suicidality, and anxiety, underscoring emerging neuropsychological risks. Adverse oral outcomes—gum disease, bone loss, and mucosal irritation—were repeatedly documented. Chemical analyses revealed urinary carcinogens and oxidative stress markers, while rare but severe complications such as explosions, burns, and nicotine poisoning were also reported.

Although short-term clinical trials found comparable rates of minor adverse events between ENDS and nicotine replacement therapy, the cumulative evidence indicates systemic harm across multiple organ systems. The authors conclude that ENDS pose measurable risks to cardiovascular, respiratory, and neuropsychological health, demanding urgent, comprehensive public health regulation, especially for youth-targeted marketing and product design.