Vaping enthusiasts will say that it’s the lesser of two evils when it comes to getting a nicotine fix, but it’s getting harder and harder to justify the idea that vaping is actually safe. The results, from a survey of over 96,000 individuals, adds three more reasons to worry about the costs of e-cigarettes over time.

Research, which will be presented at the American College of Cardiology’s 68th scientific session in New Orleans on March 18, reveals that e-cigarette use was associated with higher rates of heart attack, coronary artery disease, and, interestingly, depression. After controlling for other risk factors associated with heart conditions, the authors, led by Dr. Mohinder Vindhyal, an assistant professor of internal medicine at the University of Kansas School of Medicine, report that vapers were 34 percent more likely to have a heart attack, 25 percent more likely to have coronary artery disease, and 55 percent more likely to struggle with depression or anxiety compared to people who don’t use e-cigarettes or traditional tobacco products.

New Insight Into Vaping’s Risks

Vindhyal and his team arrived at these numbers using health data from 96,467 subjects involved in the National Health Interview Survey in 2014, 2016, and 2017. The survey collected basic health data and substance use behavior. Most pertinent to the study were the health outcomes in people who reported any vape activity, even just one time.

The FDA is currently running a campaign to highlight the dangers of vaping. YouTube/ The Real Cost

“We looked to see if someone who used e-cigarettes even once carried that risk, but I don’t think that alone gives us very accurate information,” he tells Inverse. “I believe someone that smokes on a daily basis should have much higher risks than someone who just uses it once.”

The data illuminated clear and powerful associations between e-cigarette use, coronary artery disease, heart attack, and depression. But, interestingly, the vapers still fared better that people who smoked traditional tobacco products. Cigarette smokers in the study were 165 percent more likely to have a heart attack and 94 percent more likely to have coronary artery disease.

The real takeaway from that comparison, he adds, isn’t that vaping is safer than smoking. It’s that vaping still increases the risk of conditions that are traditionally associated with smoking — and may pose unique threats.

E-Liquid’s Unique Threats

Vindhyal is specifically skeptical of e-liquids. They often contain multiple chemical components in addition to nicotine that become even more dangerous when inhaled.

“The other things that are present are carrier solids. Those should be there in the e-liquid to actually create an aerosol,” he explains. “Those are propylene glycol, ethylene glycol, and glycerol. We do know that when these become aerosolized, they are harmful for lung tissue,” he says.

But those three ingredients are only some of the components found in e-liquids. Some vape juices contain other DNA-damaging toxins, including formaldehyde. Others contain diaceytl (a butter-scented compound), which can change how genes are regulated in certain lung cells, making them more susceptible to damage. In the past, diacetyl inhalation has been associated with scarring of air sacs in the lungs — a condition sometimes called popcorn lung.

"I believe someone that smokes on a daily basis should have much higher risks than someone who just uses it once.

Vindhyal’s paper adds more context to the health of vaping, adding risk of depression, heart attack, and coronary artery disease to an increasingly long list of health concerns. But the results, it should be noted, can’t prove causality. It can just leverage data from thousands of individuals to highlight a possible connection between vaping and three serious health threats.

Even if this analysis alone can’t definitively prove that vaping causes these conditions, the results are certainly powerful enough to make you think twice before ripping your Juul.