• Posted May 6, 2022

Smoking-Plus-Vaping No Healthier Than Smoking on Its Own

Some smokers use e-cigarettes to try to kick the habit, but new research shows mixing smoking and vaping is no better for your heart health than just smoking.

Among 24,000 men and women, smoking cigarettes and e-cigarettes didn't reduce the risk of heart attack, heart failure, stroke or any cardiovascular disease.

"Our results suggest that combining smoking with e-cigarette use does not reduce cardiovascular events and that quitting both products is required to ensure a mitigation of risk," said lead researcher Jonathan Berlowitz, a medical student at Boston University.

"The cardiovascular risk of dual use did not differ from the risk among those exclusively smoking cigarettes," he added.

It's been touted that e-cigarettes are safer than regular cigarettes and those who only vaped did report fewer cardiovascular problems, but there were too few reported problems to draw a definitive conclusion that e-cigarettes are safer, the researchers noted.

E-cigarettes contain many toxic chemicals but are a popular way of getting nicotine.

"There are different reasons for the dual use of cigarettes and e-cigarettes," Berlowitz said.

"Many adults use e-cigarettes to help them reduce their cigarette use, which they hope would be a health benefit," he said. "Others may use e-cigarettes to consume nicotine in locations where cigarettes are prohibited. There is also evidence that e-cigarettes can play a gateway effect in youth leading to the later initiation of cigarettes as well. Complete cigarette cessation remains vital to reducing cardiovascular risk, regardless of e-cigarette use."

Participants took part in the Population Assessment of Tobacco and Health Study from 2013 to 2019.

The researchers found more than 1,480 cases of cardiovascular disease and more than 500 cases of heart attack, heart failure or stroke.

Compared with people who only smoked cigarettes, the people who smoked cigarettes and e-cigarettes had no significant differences in risk for cardiovascular disease, heart attack, heart failure or stroke, the researchers found.

People who only used e-cigarettes and those who used both cigarettes and e-cigarettes were younger than those who didn't use either product. Berlowitz's team found that 62% of people who only used e-cigarettes and 54% of dual users were younger than 35, compared with 51% of non-users.

Compared with only using cigarettes, using only e-cigarettes was tied with a 30% to 40% lower risk of cardiovascular disease, the researchers found. The association was only significant for any cardiovascular outcome, including congenital heart disease or myocarditis, but not for heart attack, heart failure or stroke.

The study was published May 6 in the journal Circulation.

"Their conclusions are pretty spot on. They couldn't find any evidence that using e-cigarettes was protective," said Dr. David Hill, a spokesman for the American Lung Association and an assistant clinical professor of medicine at Yale University.

"Using e-cigarettes and continuing to smoke cigarettes is not healthy," noted Hill, who wasn't part of the study.

Evidence that vaping helps people quit smoking is weak, he pointed out, and the U.S. Food and Drug Administration hasn't approved e-cigarettes as a way to quit smoking.

"What the data is really saying is that the majority of people who use tobacco products are, unfortunately, not stopping smoking, but continuing to use both. It's a frustrating thing," Hill said. "The concept of them being a tobacco cessation product is more marketing than science-based."

The challenge with e-cigarettes is that the long-term effects aren't known, because they haven't been around that long, Hill said.

"There is no safe tobacco product, including e-cigarettes," Hill said. "These are addictive and have the potential to cause harm. If you're looking to stop smoking, there are much better methods available to help people quit."

More information

For more on e-cigarettes, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Jonathan Berlowitz, BA, medical student, Boston University; David Hill, MD, volunteer medical spokesman, American Lung Association, assistant clinical professor, medicine, Yale University, New Haven, Conn.; Circulation, May 6, 2022, online