Is Vaping Really Worse Than Smoking?

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One of the arguments for allowing e-cigarettes to continue to be sold has been that for people trying to quit smoking tobacco, vaping was the best action a smoker could take against the known hazards of smoking tobacco. The U.S. Food and Drug Administration (FDA), although it did not approve e-cigarettes as an aid for quitting tobacco, nevertheless did not regulate e-cigarettes or the various liquids that hit the market.

Last Friday, November 8, the U.S. Centers for Disease Control and Prevention (CDC) announced that it had received reports of 2,051 cases of e-cigarette or vaping product associated lung injury (EVALI) and 39 deaths as of November 5. The CDC also announced that a toxin, vitamin E acetate, was found in all 29 samples collected from EVALI patients and that THC, the psychoactive ingredient in marijuana, was found in 23 of the samples. Nicotine was found in 16 samples. The CDC calls vitamin E acetate “a toxin of concern.”

The arguments against e-cigarettes are about to get even stronger. In two studies to be presented this weekend at the American Heart Association’s (AHA) Scientific Sessions 2019 meeting in Philadelphia, the effect of vaping on heart health gets center stage.

Rose Marie Robertson, M.D., FAHA, the AHA’s deputy chief science and medical officer, commented, “There is no long-term safety data on e-cigarettes. However, there are decades of data for the safety of other nicotine replacement therapies.”

The CDC, in September, said essentially the same thing in a statement: “E-cigarettes containing nicotine have the potential to help some individual adult smokers reduce their use of and transition away from cigarettes. However, e-cigarettes are not currently approved by the Food and Drug Administration (FDA) as a quit smoking aid, and the available science is inconclusive on whether e-cigarettes are effective for quitting smoking.”

What e-cigarettes do seem to be effective at is causing more health problems. In one study that will be reported this weekend, researchers found that total cholesterol levels were lower and that bad cholesterol (LDL) was higher in e-cigarette users compared to nonsmokers. Good cholesterol (HDL) levels were also lower in people who used both e-cigarettes and were tobacco smokers.

Dr. Sana Majid, an author of the study, said, “Although primary care providers and patients may think that the use of e-cigarettes by cigarette smokers makes heart health sense, our study shows e-cigarette use is also related to differences in cholesterol levels. The best option is to use FDA-approved methods to aid in smoking cessation, along with behavioral counseling.”

The second study being reported this weekend found that vaping is associated with coronary vascular dysfunction and that “the effect might be worse than from smoking traditional cigarettes.” Researchers analyzed heart blood flow in 19 young adults (ages 24 to 32) immediately before and after vaping or smoking a cigarette. Study author Dr. Florian Rader noted, “In smokers who use traditional cigarettes, blood flow increased modestly after traditional cigarette inhalation and then decreased with subsequent stress. However, in smokers who use e-cigs, blood flow decreased after both inhalation at rest and after handgrip stress. These results indicate that e-cig use is associated with persistent coronary vascular dysfunction at rest, even in the absence of physiologic stress.”

Co-author Dr. Susan Cheng, added, “We were surprised by our observation of the heart’s blood flow being reduced at rest, even in the absence of stress, following inhalation from the e-cigarette. Providers counseling patients on the use of nicotine products will want to consider the possibility that e-cigs may confer as much and potentially even more harm to users and especially patients at risk for vascular disease.” They are not the only product people think is better than alternatives when, in fact, it does a lot of damages. Here are 21 “harmless habits that are actually aging you faster than you can imagine.

If the single trumpeted benefit of vaping — that it is not as bad as smoking — is proved false, then the product positioning of many e-cigarette products as a safe alternative to smoking pretty much evaporates. Companies that make e-cigarettes (or that have invested billions in them) have two choices: admit that their products are not a safe alternative to smoking tobacco or continue peddling a story that is already falling apart. If they choose the first alternative, then there is no reason for e-cigarettes and their associated products to exist. So number two it will be.