Effects of smoking cessation interventions on vascular health markers: a scoping review

This scoping review aims to map prospective evidence on the vascular effects of major smoking cessation therapies, including pharmacotherapy, nicotine replacement therapy and exclusive switching to electronic cigarettes, in adult smokers. A comprehensive search of PubMed, Scopus and Web of Science was conducted on December 2, 2025. Eligible studies included randomized controlled trials, quasi-experimental designs and prospective cohort studies reporting quantitative or narrative findings on vascular function following smoking cessation or exclusive electronic cigarette use. Only studies with at least 1 week of follow-up and resting vascular measurements were included. Data were charted using a standardized extraction template and synthesized narratively, consistent with scoping review methodology. Twenty-two prospective studies met the inclusion criteria. Pharmacotherapy-assisted cessation, nicotine replacement therapy and exclusive switching to electronic cigarettes were all associated with improvements in vascular outcomes among participants who fully abstained from combustible cigarettes. Increases in flow-mediated dilation were observed across treatment categories, with several studies reporting measurable gains within the first 3 to 12 months. Reductions in pulse-wave velocity and augmentation index also emerged in most cohorts, although effect sizes varied according to study design, follow-up duration and population characteristics. Evidence from studies on exclusive electronic cigarette use, although limited in number, showed improvements in endothelial function and arterial stiffness comparable to those observed with conventional cessation therapies. Prospective evidence indicates that multiple smoking cessation therapies, including exclusive switching to electronic cigarettes, may be associated with early improvements in vascular function when combustible cigarette exposure is fully eliminated. The evidence base remains constrained by heterogeneity, small sample sizes and short follow-up, particularly within studies on electronic cigarette switching. Larger and long-term prospective studies are needed to clarify the durability and clinical implications of these early vascular changes.