Vascular health after quitting smoking or switching to e-cigarette use: a systematic review of prospective studies with GRADE assessment
Authors' conclusion
Smoking cessation appears to improve vascular function, as reflected by early favorable changes in endothelial and arterial stiffness markers; however, the overall certainty varies from moderate to very low, according to the outcome.
Study context
- Population
- Adult smokers
- Participants
- 11,702 smokers · 23 studies
- Comparison
- Smoking cessation or switching to exclusive e-cigarette use
- Outcome
- Vascular function (PWV, AIx, FMD)
Methodological detailsGRADE assessment, qualitative synthesis, 14 cohort studies, 5 quasi-experimental and 4 randomized controlled trials (RCTs), Risk of bias by Joanna Briggs Institute tools
- GRADE assessment
- Qualitative synthesis
- 14 cohort studies, 5 quasi-experimental and 4 RCTs
- Risk of bias by Joanna Briggs Institute tools
Pooled result
As reported in the abstract
- Smoking cessation consistently associated with improvements in pulse wave velocity (PWV), augmentation index (AIx) and flow-mediated dilation (FMD), some within one month and sustained up to 24 months
- Overall certainty of evidence very low, except moderate for RCTs on FMD
- Improvements across cessation methods, including pharmacotherapy and electronic cigarette (ECs)
- Qualitative synthesis
Further pooled results
FMD in RCTs of e-cigarettes
- Significant improvements in FMD irrespective of nicotine content
Sensitivity analyses excluding lower-quality RCTs
- Confirmed the primary findings
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Vascular health after quitting smoking or switching to e-cigarette use: a systematic review of prospective studies with GRADE assessment. Eur J Prev Cardiol. Published 24 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it