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Effect of E-Cigarette Use Either Alone or Concurrently With Cigarettes vs Cigarettes Alone on Health Outcomes
TAKE-HOME MESSAGE
- This study compared the effect of e-cigarette use either alone or concurrently with cigarettes with that of conventional cigarettes alone on health outcomes. The odds of developing disease associated with e-cigarette use were comparable to those associated with cigarette smoking for cardiovascular diseases, stroke, and metabolic dysfunction but were lower for asthma, COPD, and oral disease. However, the reduced odds of developing asthma, COPD, and oral disease with e-cigarette use compared with cigarette use were 3 to 10 times higher than the risk reported by the FDA and Public Health England. Furthermore, the odds of developing diseases were 20% to 40% higher with concurrent use than with cigarette use alone.
- These findings highlight the substantial risk of developing systemic and oral diseases with e-cigarette use, particularly among concurrent users. The assumption that e-cigarettes are less harmful than conventional cigarettes must be reassessed.
abstract
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NEJM Evidence
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes
NEJM Evid 2024 Mar 01;3(3)EVIDoa2300229, SA Glantz, N Nguyen, AL Oliveira da SilvaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In 2021, it was estimated there were 86 million vapers of e-cigarettes world-wide, and since then the number has increased rapidly.
The debate about e-cigarettes has lasted almost 2 decades. The paper of Glantz et al is of great public health importance as this is the first meta-analysis to provide risk estimates associated with e-cigarette use compared with conventional smoking. The results question the health benefits of switching from smoking to vaping. Specifically, the risks associated with e-cigarette use were similar to those associated with smoking for cardiovascular disease, stroke, and metabolic dysfunction. The meta-analysis also found that odds of respiratory and oral diseases were significantly lower than the odds with conventional smoking, but risk reduction was low.
In some populations the majority of vapers also smoke (dual use), and the meta-analysis found that dual use was always riskier than just smoking.
Big challenges in e-cigarette research are that follow-up time might be too short for some disease outcomes, but this problem means that current studies might underestimate the risks. Many vapers are former smokers, but Glantz et al showed that whether or not individual studies accounted for former smoking did not affect the results. More importanty, studies including never-smokers also showed significantly higher odds of disease in vapers compared with those who do not vape. The biggest challenge in this meta-analysis is that only 30 of the 124 included large population-based studies are longitudinal, the rest are cross-sectional and can therefore not provide information on causality. However, there was no difference in the risk estimates in cross-sectional and longitudinal studies.
A paper can never stand alone. Thousands of e-cigarettes studies have been performed and their findings support that vaping is harmful. E-cigarette aerosol contains many toxic and carcinogenic substances. In vivo and in vitro studies, animal studies and human experiments have described the harmful effects of vaping and proposed the mechanisms of harm. For example, studies show that vaping may play a role in periodontal disease by altering the host response, resulting in the release of inflammatory cytokines and in having a negative influence on the periodontal microflora.
Long-term use of e-cigarettes is probably much more harmful than first expected.