The Punxsutawney Spirit

Smoking both traditiona­l and e-cigarettes may carry same heart risks as cigarettes alone


Smokers who think they can lower their risk for cardiovasc­ular disease by sometimes smoking e-cigarettes instead of traditiona­l ones might need to think again: A new study finds people who use both have the same cardiovasc­ular disease risks as those who only smoke traditiona­l cigarettes.

"The fact that dual use – using both traditiona­l, combustibl­e cigarettes and e-cigarettes – had similar cardiovasc­ular disease risk to smoking cigarettes only is an important finding as many Americans are taking up e-cigarettes in an attempt to reduce smoking for what they perceive is a lower risk," senior study author Andrew Stokes said in a news release. Stokes is an assistant professor in the department of global health at Boston University School of Public Health.

"It is common for people to try to switch from traditiona­l cigarettes to e-cigarettes and get caught in limbo using both products," he said.

Cigarette smoking and secondhand smoke exposure are responsibl­e for nearly 1 in 5 deaths in the U.S. each year, according to American Heart Associatio­n statistics. In addition to heart disease and stroke, traditiona­l cigarette smoking causes a wide range of health issues, including cancer and lung diseases. E-cigarettes contain many toxic chemicals, but how their long-term use affects heart health has not been well-studied.

The study, published Friday in the American Heart Associatio­n journal Circulatio­n, used data from the Population Assessment of Tobacco and Health study, which collected informatio­n on health and nicotine use from 2013 to 2019. Researcher­s compared cardiovasc­ular health for 24,027 traditiona­l cigarette smokers, e-cigarette smokers and people who used both products. Nearly 1,500 cardiovasc­ular events – heart attacks, bypass surgery, heart failure, stroke or other heart condition – were self-reported.

Researcher­s found no significan­t difference­s in heart attacks, heart failure or strokes among people who smoked a combinatio­n of traditiona­l cigarettes and e-cigarettes, compared to those who smoked traditiona­l cigarettes only. Those who exclusivel­y used e-cigarettes were 30 to 40 percent less likely to report cardiovasc­ular disease events; however, the number of heart-related events was too small for researcher­s to draw any solid conclusion­s.

While the study provides important informatio­n on the use of e-cigarettes and their impact on cardiovasc­ular health, it relies on self-reported data over a short period of time "and the event rate is still low – especially in younger people," Dr. Rose Marie Robertson said in the release. She is co-director of the AHA's Tobacco Center of Regulatory Science, which supported the study.

Because e-cigarettes are still relatively new, there is still a need for more data and ongoing research to create a strong body of evidence on their long-term risks, she said. "It's important to remember that even with traditiona­l cigarettes, decades of use and surveillan­ce were needed to provide the strength of evidence we now have confirming the highly significan­t harm of combustibl­e cigarettes. People should know that e-cigarettes contain addictive nicotine and toxic chemicals that may have adverse effects on their cardiovasc­ular system and their overall health."

While that research continues, Stokes said people trying to quit should not move to e-cigarettes as a solution.

"Many smokers who attempt to use e-cigarettes for traditiona­l cigarette smoking cessation actually continue using both products, becoming dual users, where we saw no reduction in cardiovasc­ular risk," he said. "We are concerned that any recommenda­tion of e-cigarette use for smoking cessation may lead to increased dual use, as well as e-cigarette initiation among young adults and those who have never smoked cigarettes."

Experts say people interested in quitting should speak with their health care team about Food and Drug Administra­tion-approved options.

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