A new Cedars-Sinai study found that e-cigarettes placed a greater strain on the heart than traditional tobacco products.

In case there wasn’t enough of a public health worry over vaping and e-cigarettes, new research adds to the concerns. A new study from the Smidt Heart Institute at Cidars-Senai shows that using vaping products could place a greater harm on the heart than smoking cigarettes or traditional tobacco delivery devices.

“What makes e-cigarettes so harmful to the heart and lungs is not just nicotine,” said senior author Florian Rader said in a statement. “It’s the completely unknown bucket of manufactured products used to form vapors that is likely causing the most harm. This is what we believe is underlying the current public health problem.”

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The Cidars-Senai researchers collected measurements of 30 healthy young adults ages 18 to 38, 10 of whom were tobacco smokers, 10 e-cigarette users, and 10 non-smokers. The researchers compared participants’ blood flow to the heart muscle in two different exercises: before and after using nicotine, as well as before and after conducting a handgrip exercises physiologic stress.

For traditional cigarette users, blood flow increased slightly after smoking while at rest, but decreased following subsequent stress. E-cigarette users, however, saw decreases in blood flow after inhalation, regardless if they were at rest or placed under stress.

“This suggests e-cigarettes cause an abnormality that impedes blood flow regulation in the heart,”  Rader told Time.

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Rader added that the study was too small in scope to provide any definitive answers about the vaping crisis and what long-term health problems e-cigarettes pose. The researchers also did not control for the use of cannabinoids like THC or CBD. A significant amount of vape use includes these elements and stands at the center of our current vaping crisis.

Still, the study comes at a crucial time for American e-cigarette use. A recent Food and Drug Administration study, cited by the Cidars-Senai researchers, found that e-cigarette use is rising for adolescents. In 2018, 20.8% of high schoolers used e-cigarettes, a figure that has since risen to 27.5% in 2019. Furthermore, the FDA estimated that last year 3.62 million middle and high school students consumed e-cigarettes.