Electronic cigarettes (e-cigarettes) are often promoted as an alternative to smoking. A study published in JAMA Cardiology has added to growing evidence that e-cigarettes are not harmless.
"Studies like this give further confirmation that e-cigarettes are
not harmless," said European Society of Cardiology cardiovascular
prevention spokesperson Professor Joep Perk.
‘Habitual e-cigarette users have increased cardiac sympathetic activity and increased oxidative stress - known mechanisms by which tobacco cigarettes increase cardiovascular risk.’
"If I was a minister of health I would put my efforts into public
anti-smoking campaigns especially directed towards the younger
generation, and not promote e-cigarettes as an alternative to smoking,"
he continued. "There are studies also showing that people that start
with e-cigarettes have a tendency to become persistent tobacco cigarette
smokers as well."
The 2016 European guidelines on cardiovascular disease prevention
flagged up the need for further research on the long-term effects of
The current study included 23 habitual e-cigarette users (used most
days for at least one year) and 19 non-users between the ages of 21 and
45 years. It found that habitual e-cigarette users were more likely than
non-users to have increased cardiac sympathetic activity (increased
adrenaline levels in the heart) and increased oxidative stress - known
mechanisms by which tobacco cigarettes increase cardiovascular risk.
The authors said the findings "have critical implications for the
long-term cardiac risks associated with habitual e-cigarette use" and
"mandate a re-examination of aerosolized nicotine and its metabolites".
They added that causality could not be confirmed on the basis of this
single, small study, and that further research into the potential
adverse cardiovascular health effects of e-cigarettes is warranted.
"Nicotine stimulates the central nervous system, so it's not at all
surprising that people continuously taking nicotine get this sympathetic
stimulation," said Professor Perk. "This then might lead to irregular
heartbeat and raised blood pressure, and probably has long-term
deleterious effects on the blood vessel walls."
"It is too large a step to say that these negative effects are proof
that people are going to die early because they used e-cigarettes," he
continued. "To prove this you have to put people on e-cigarettes for 10
to 15 years and see how many die early - a study that will not be done
for ethical reasons. The weakness of all studies in this field is that
they are observational and small, and they look at indicators of
vascular wall damage rather than incidence of cardiovascular disease or
Professor Perk said that, even after this study, e-cigarettes could
still be used to help people stop smoking tobacco cigarettes, but they
should be used with caution and other methods should preferably be tried
He said: "E-cigarettes are one of the tools we have in nicotine
replacement therapy but as clinicians we should be cautious of putting
people on large amounts of central nervous system stimulant drugs. Other
smoking cessation schemes, such as chewing gum or patches, always
include the decision to taper off use and eventually stop. This is not
in general the case with e-cigarettes, which tend to be seen as a
replacement and not a weaning off nicotine addiction. In fact they
prolong the addiction."
"This is an area where we need more knowledge," continued Professor
Perk. "The more data we collect, the more it seems that nicotine
replacement strategies that taper off and ultimately end nicotine use
are the way to go."
"At the end of the day the best thing is simply to prevent people ever getting into the vicinity of nicotine," he concluded.