Electronic Cigarettes as an Alternative Option for Quitting Smoking?

Less Harmful, Not Healthier

Electronic cigarettes are classified as so-called ENDS (electronic nicotine delivery systems). This term refers to all products operating on a similar principle, which release nicotine by heating a tobacco extract. However, some devices on the market do not contain nicotine. According to the stance of the World Health Organization (WHO), the exact composition of substances inhaled when using electronic cigarettes is not yet known. However, available analyses show that the spectrum and amount of toxic and carcinogenic substances appear significantly lower than in the case of traditional tobacco products.

The presence of toxic substances in electronic cigarette vapors has been repeatedly proven, including tobacco-specific nitrosamines, acetone, formaldehyde, polyhalogenated hydrocarbons, and diethylene glycol, albeit in very small and variable amounts.

According to Prof. MUDr. Eva Králíková, CSc., chairwoman of the Society for the Treatment of Tobacco Dependence, it is necessary to acknowledge with common sense that the composition of “e-smoke” will be less dangerous than smoking traditional cigarettes, which contain thousands of harmful substances. She compares the rejection of electronic cigarettes to the rejection of a varied vegetable diet as a healthier alternative to processed meats simply because trace amounts of toxic substances have been found in vegetables.

Electronic cigarettes should thus be viewed as a less harmful alternative to smoking, but not as a generally “healthier” tobacco product. Many published studies have shown that electronic cigarettes are an effective method for quitting smoking tobacco products, even for those who did not plan to quit smoking. However, the results of studies regarding health benefits are inconsistent, although many of them indicate that switching to electronic cigarettes from traditional ones reduces the risk of cardiovascular and respiratory diseases.

Current Study Findings

George et al. published a prospective randomized study in which they evaluated the impact of switching from cigarettes to electronic cigarettes on cardiovascular parameters. The total duration of the study was 1 month, completed by 114 patients (40 on cigarettes, 37 on electronic cigarettes with nicotine, and 37 on electronic cigarettes without nicotine). Inclusion criteria included age ≥ 18 years, a history of smoking ≥ 15 cigarettes/day for ≥ 2 years, and no proven cardiovascular disease. After one month, patients on both forms of electronic cigarettes showed a significant improvement in endothelial function assessed by brachial artery flow-induced dilation, as well as a significant improvement in arterial stiffness parameters. Greater benefits were observed in women and in both electronic cigarette regimes (± nicotine) without significant mutual difference.

Goniewicz et al. published a systematic review examining the effectiveness of switching to electronic cigarettes in reducing cardiovascular and respiratory risks in smokers. The review included a total of 6 studies with a variable number of participants (from 19,475 to 161,529). In 3 studies, respiratory risks (including COPD, chronic bronchitis, emphysema, asthma) were evaluated, with resulting odds ratios (OR) for former smokers using electronic cigarettes compared to active cigarette smokers ranging from 0.58–0.66. In the other 3 studies evaluating cardiovascular risks (including acute myocardial infarction, stroke, and ischemic heart disease), OR values did not significantly differ from 1.

Conclusion

Electronic cigarettes remain a controversial topic today. Given that a significant portion of addicted smokers cannot overcome their addiction despite intensive treatment, they may represent an alternative for quitting smoking. Electronic cigarettes have been shown to have borderline low exposure to carcinogens and other toxic substances and certain benefits in terms of cardiovascular and respiratory risks. However, it remains true that the only beneficial and safe option is to completely quit smoking, including electronic cigarettes.

(holi)

Sources:
1. Králíková E., Ježek M. Electronic Cigarettes. Časopis lékařů českých 2012; 151: 208–211. Available at: www.prolekare.cz/casopisy/casopis-lekaru-ceskych/2012-4-5/elektronicke-cigarety-37911
2. George J., Hussain M., Vadiveloo T. et al. Cardiovascular effects of switching from tobacco cigarettes to electronic cigarettes. J Am Coll Cardiol 2019; 74 (25): 3112–3120, doi: 10.1016/j.jacc.2019.09.067.
3. Goniewicz M. L., Miller C. R., Sutanto E., Li D. How effective are electronic cigarettes for reducing respiratory and cardiovascular risk in smokers? A systematic review. Harm Reduct J 2020; 17 (1): 91, doi: 10.1186/s12954-020-00440-w.