E-cigarettes have long been marketed as a safer alternative to regular tobacco smoking, possibly because they expose users to fewer toxic chemicals. However, new research from the University of Pennsylvania focused on vascular effects of smoking tobacco, vaping with nicotine and vaping without nicotine. This on-going research was presented to the Radiological Society of North America. It demonstrated that both tobacco smoking and vaping reduces blood flow in a main artery supplying blood to the lower extremities. Vaping that includes nicotine shows the greatest harm immediately after use. Authors suggest that regular vaping will eventually cause vascular disease. The take home message is that vaping may not be free from harm.