Your Weekly Checkup: Electronic Cigarettes Revisited

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I have written previously about vaping and the use of electronic cigarettes. I stated that an expert committee of the National Academies of Sciences, Engineering, and Medicine concluded, “There is no available evidence whether or not e-cigarette use is associated with clinical cardiovascular outcomes (coronary heart disease, stroke, and peripheral artery disease) and subclinical atherosclerosis (carotid intima media-thickness and coronary artery calcification) but that heart rate…and blood pressure rose acutely after e-cig exposure.” I wrote in April that vaping may be safer than traditional smoking, but we needed more studies to be sure. I also noted that nicotine is addicting, whether in an e-cigarette or conventional cigarette.

More recent information requires an update of those comments.

Many people smoke e-cigarettes for one of three reasons:

1. They think e-cigarettes are safer
2. They believe they can smoke them in places where they are not allowed to smoke conventional cigarettes
3. They use them to quit smoking conventional cigarettes

All three of those beliefs appear to be wrong. E-cigarettes do not appear to be safer, they are often forbidden in the same places conventional cigarettes are forbidden, and they actually may make it harder to quit conventional smoking.

Researchers at the University of California, San Francisco, analyzed data from 69,725 people who underwent in-person interviews as part of the National Health Interview Surveys in 2014 and 2016. Respondents characterized their use of traditional or e-cigarettes by choosing never, former, some days, or daily. Researchers found that most adults who used e-cigarettes continued to smoke traditional cigarettes.

Daily e-cigarette use appeared to be independently associated with an elevated risk for heart attack, as was daily conventional cigarette use. Transitioning completely from cigarettes to e-cigarettes was still associated with an increased heart attack risk since e-cigarettes pose an independent risk different than cigarettes. Some of the mechanisms by which they act are common, but there are independent effects. E-cigarettes represent a different kind of toxic exposure.

Daily use of electronic cigarettes almost doubled a person’s risk for heart attack, while those who reported daily use of both electronic and conventional cigarettes appeared 4.6 times as likely to have a heart attack than those who never used either product.

A primary toxic agent in e-cigarettes may be the ultrafine particles contained in the aerosol created by heating a liquid solution of nicotine. Those ultrafine particles have serious negative short-term and long-term effects on cardiovascular function. In addition, the nicotine impacts the nervous system in ways that are associated with heart disease risk. There are many strong oxidizing chemicals in e-cigarettes — such as acrolein — that are associated with heart disease risk. Harmful effects can occur within minutes.

For those with lung cancer, e-cigarettes appear to deliver a lower level of cancer-causing chemicals than traditional cigarettes, but the cardiovascular effects are very serious. Exposure to nicotine can make cancer worse by promoting growth of blood vessels into tumors, as well as other changes that may make tumors grow faster. I would not recommend e-cigarettes for conventional smokers with lung cancer.

Many strategies exist to help people stop smoking, such as nicotine replacement therapy or prescription drugs, combined with counseling, and work quite well for motivated individuals. If individuals are already using e-cigarettes and do not want to change, at the very least they should stop combined use with cigarettes.

I’ll reiterate the advice I gave in April: The safest recourse is not to smoke. Period!