Smoking is the main risk factor for lower-limb peripheral arterial disease (LL-PAD). E-cigarette could be an aid to quitting smoking. According to the literature, vaping causes early biological and preclinical vascular changes (increased arterial stiffness, induction of oxidative stress and vascular inflammation), all of which being involved in the development of atherosclerosis. However, the role of vaping in the occurrence of clinical events related to atherosclerosis has not been proven, and no studies have evaluated the frequency of vaping and how it is perceived by patients with LL-PAD.

The objective of this study was to study the frequency of vaping and the perception of its health risks among patients with LL-PAD.

Cross-sectional study conducted in the Vascular Medicine Department of Saint-Etienne University Hospital (November 2024–March 2025, ethics committee Nb. IRBN1502024/CHUSTE) including patients with LL-PAD. Data (smoking status, vaping and perceptions of its health risks) were collected using a standardized questionnaire.

Two hundred patients were included: mean age 69.3 ± 11.0 years, 82.5% males, 21% smokers, 71.5% ex-smokers, 17.5% vapers (9.5% vapers ex-smokers, 8% vapers and smokers, no exclusive vapers). Vapers were significantly younger than non-vapers (62.3 ± 11.2 vs 70 ± 10.4 years; P < 0.0001). Thirty-five per cent of vapers answered that vaping has a harmful effect on cardiovascular, neurological or pulmonary health; 47% said that they did not know and more than half of vapers answered that vaping was less dangerous than tobacco smoking.

There is a lack of clear, scientifically substantiated information on the actual effects of e-cigarette, particularly on specific damage to different organs. For the moment, preclinical data in healthy subjects show an acute impact of vaping in terms of oxidative stress, vascular inflammation, and increased arterial stiffness. Regarding the impact of e-cigarettes on cardiovascular disease, the results are mixed, making it impossible to conclude whether e-cigarette is dangerous or harmless.

Among patients with LL-PAD, vaping remains limited. Perceptions of its risks are mixed and marked by considerable uncertainty  These results highlight the need for healthcare professionals to inform patients about the potential risks of vaping (biological and preclinical data). Prospective studies are needed to clarify the clinical risk in this population at very high cardiovascular risk.