A study published today in the Journal of the American College of Cardiology (JACC) provides the most fascinating news for smokers who have managed to quit using e-cigarettes. Improvements in vascular function were observed as early as 1 month after making the switch. Similar improvements were observed for those using nicotine-containing and nicotine-free e-cigarettes, debunking a common myth (which has already been disproven through snus research) that nicotine contributes substantially to smoking-related cardiovascular risk. Even more remarkably, improvements in vascular function were observed even in those who did not completely quit smoking but substantially reduced their smoking consumption. This is another important piece of information, especially for those who still insist that dual use (which includes vapers who smoke one cigarette per day or smoke less than daily) has no benefit or may be associated with higher risk compared to smoking only.
The study measured arterial stiffness and endothelial function, which are markers with important prognostic significance. To simplify this, increased arterial stiffness and endothelial dysfunction are well-established predictors of higher risk for future development of cardiovascular disease. But someone might say that only 3 days ago another study reported the opposite findings: that e-cigarettes cause increased arterial stiffness and endothelial dysfunction. Well, THIS IS WRONG.
The previous study published by a group of German researchers is one of the many studies which evaluated the changes in arterial stiffness and endothelial function immediately after using an e-cigarette for few minutes. The study was accompanied by an impressive press release from the European Heart Association, declaring that they have established “how e-cigarettes damage the brain, blood vessels and lungs”. However, their methodology and findings have no prognostic value at all! They provide no evidence that the risk for future heart disease is increased (or decreased). The reason is simple: these markers have NEVER been used and validated as prognostic indicators when measured after an acute intervention (in this case, after delivering a stimulant such as nicotine). In fact, the guidelines in measuring these markers dictate that stimulants such as caffeine, nicotine and alcohol (or even food) should be avoided for several hours before the measurements. Characteristically, nicotine replacement therapies and caffeine have the same immediate effects of vascular function as nicotine, but they do not confer any risk for future development of heart disease. Coincidentally, just yesterday I presented all these facts at the E-Cigarette Summit 2019, without knowing about the study which was just published. However, I am not a prophet and I am not more intelligent that the authors of the many studies who interpret the acute effects of nicotine (which are known since the 1960s) as a sign of future disease. I find it very problematic for the scientific community that only a few days after declaring that e-cigarettes are disastrous for the heart, a study makes it clear that cardiovascular benefits are expected when switching from smoking to e-cigarette use.
The study published today in Journal of the American College of Cardiology (JACC) is groundbreaking. It should be seriously considered by scientific societies in changing their approach to the issue of e-cigarettes. While the study made no comparison with other smoking cessation methods (or with quitting without the use of any aid), this is irrelevant. Everyone should encourage smokers who are unable or unwilling to quit using approved medications to try e-cigarettes in an effort to quit. Besides the benefits in reducing cancer risk, we now have an important study showing improvement in vascular function in a very short period of time which may be translated to lower risk for cardiovascular disease based on the strong prognostic significance of the markers measured. I wonder what the reaction of the scientific community will be after this study.
It is time for everyone to be more open-minded and look at the evidence away from predisposition and prejudice.
Author: Dr Konstantinos Farsalinos
Date: Saturday, 16 November 2019