The combined use of electronic cigarettes and smoked tobacco would expose people to as many cardiovascular risks as cigarettes alone.

A US study indicates that cardiovascular risks would be reduced in exclusive vapers, but that this benefit would disappear when vaping is combined with smoking.

The cardiovascular consequences of smoking have been well documented for several decades.[1]. Those linked to the use of electronic cigarettes would be less but are still debated, due to lack of sufficient hindsight. A US study published in the journal Circulation today provides some additional details[2].

Exploitation of a longitudinal study on coronary risks

Based on 2013-2019 data from the national cohort study Population Assessment of Tobacco and Health (PATH), this study identified cardiovascular events (myocardial infarction, coronary artery bypass grafting, cardiovascular accidents, heart failure, etc.) of participants by putting them into perspective with their smoking status and their use of e-cigarettes.

The 24,027 eligible participants were divided into four groups: non-smokers (including ex-smokers and ex-vapers), cigarette smokers, exclusive users of e-cigarettes and dual users of smoked cigarettes and e-cigarettes. Young smokers were given priority in order to reach 50% of the sample, while women represented 51% of the sample. Exclusive users of e-cigarettes and dual users of cigarettes and e-cigarettes were generally younger than non-smokers.

The dangers of dual use of e-cigarettes/tobacco are similar to those of cigarettes

The results of this study show similar risks of cardiovascular events between cigarette smokers and dual users of smoked tobacco and e-cigarettes, the latter presenting a significant risk compared to older non-smokers. Exclusive users of e-cigarettes would display 30 % to 40 % fewer cardiovascular events, these results however need to be confirmed given the small size of the sample and the rarity of cardiovascular events in this group. The authors conclude that it is necessary to stop dual use of tobacco and e-cigarettes as soon as possible, and encourage their users to stop using these two products.

The study does, however, have several limitations, including the short duration of follow-up, the self-reporting of participants, particularly for the qualification of the cardiovascular events sought, and the absence of a reference group of ex-smokers among non-smokers. This last point constitutes one of the recurring weak points of studies on electronic cigarettes, in that it does not sufficiently distinguish ex-smokers from people who have never smoked.

A strong incentive to abandon dual use, as well as both products

"The use of e-cigarettes is still relatively new and there is no long-term evidence yet to determine the potential risks of their use over time, so we look forward to gathering more data and studies that would allow this.", said Rose Marie Robertson, co-director of the American Heart Association's (AHA) Tobacco Center of Regulatory Science and sponsor of the study[3]. “E-cigarettes are not approved by the Food and Drug Administration (FDA) for smoking cessation. We strongly recommend that people who smoke and want to quit talk to their doctors and healthcare teams about effective FDA-approved smoking cessation options.”, she added.

Andrew Stokes, one of the study's authors, said: "We are aware that any recommendation of electronic cigarettes for smoking cessation may lead to an increase in dual use."[4] A precaution that is all the more important to emphasize since, according to him, "many Americans are switching to electronic cigarettes, which they perceive as a lower risk, with the aim of simply smoking less tobacco." While it therefore seems too early to comment on the real cardiovascular consequences of long-term exclusive consumption of electronic cigarettes, the combined use of electronic cigarettes and tobacco does not reduce the risks and should therefore be banned.

Keywords: cardiovascular risks, dual use, electronic cigarette, smoking,

M.F.

[1] Tobacco and cardiovascular diseases: major, early and often fatal risks, Generation Without Tobacco, published on December 27, 2019, consulted on May 10, 2022.

[2] Berlowitz, JB, et al. (2022) E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019. Traffic. doi.org/10.1161/CIRCULATIONAHA.121.057369.

[3] Henderson E, Combined use of traditional cigarettes and e-cigarettes does not reduce cardiovascular disease risk, News Medical, published May 6, 2022, accessed May 10, 2022.

[4] No health benefits among adults who used both e-cigarettes and traditional cigarettes, Newsroom/AHA, published May 6, 2022, accessed May 10, 2022.