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While it is generally unclear whether toxicity from e-cigarettes stems from higher nicotine concentrations or rapid delivery mechanisms, it is hypothesized that increased plasma concentration and higher bioavailability of nicotine, depending on the isomer of nicotine, make it faster to be absorbed into circulation, hence why its effects may be exaggerated

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The researchers also looked at health outcomes by how often someone reported using e-cigarettes, either daily or some days. When compared to non-e-cigarette users, daily e-cigarette users had higher odds of heart attack, coronary artery disease and depression/anxiety, whereas some days users were more likely to have a heart attack and suffer from depression/anxiety, with only a trend toward coronary artery disease