Monday, January 25, 2016

Switching to Electronic Cigarettes Improves Cardiovascular Health of Smokers, Even Among Dual Users

There is already strong evidence that switching from smoking to electronic cigarettes results in immediate improvement in the respiratory health of asthmatic smokers. This improvement occurs among both those who switch completely and those who become dual users but cut down substantially on the amount that they smoke.

Today, I report the results from a new study which demonstrates that switching from smoking to electronic cigarettes also improves the cardiovascular health of smokers, an effect observed both among those who switch completely to e-cigarettes and those who become dual users but cut down on the amount that they smoke.

(See: Farsalinos K, et al. Effect of continuous smoking reduction adn abstinence on blood pressure and heart rate in smokers switching to electronic cigarettes. Intern Emerg Med 2016. Published online on January 9, 2016. DOI: 10.1007/s11739-015-1361-7.)

The study involved a clinical trial in which smokers were offered the opportunity to switch to electronic cigarettes. They were then followed for one year. Over the course of the year, some of the smokers switched completely to e-cigarettes, others reduced the amount they smoked by more than half, and others failed to either quit or substantially reduce their smoking. The study reported that among smokers with high blood pressure at baseline, there was a significant reduction in blood pressure at one year follow-up among those who switched to e-cigarettes completely or who remained dual users by cut their cigarette consumption by at least 50%.

The magnitude of the observed changes in blood pressure was substantial. Among smokers with baseline hypertension who switched completely to e-cigarettes, systolic blood pressure declined by an average of 16.3 mm Hg. Among smokers who cut their cigarette consumption by more than half (although remaining dual users), systolic blood pressure declined by an average of 10.8 mm Hg.

The reduction in blood pressure remained statistically significant after adjusting for age, sex, and weight change. The estimated average decline in systolic blood pressure for smokers who quit by switching to e-cigarettes was 14 mm Hg, and for smokers who cut down substantially using e-cigarettes was 7 mm Hg.

Finally, no further decrease in blood pressure was observed among those subjects who quit using both cigarettes and electronic cigarettes.

The Rest of the Story

These results demonstrate that smokers who either quit smoking or greatly reduce the amount of their smoking by switching to electronic cigarettes experience an improvement in their cardiovascular health; specifically, a lowering of their blood pressure. This improvement is most striking among smokers with high blood pressure at baseline. The magnitude of the blood pressure decline is substantial, and is about twice as high among quitters as among dual users who substantially reduce their cigarette consumption. Quitting the use of electronic cigarettes as well as tobacco cigarettes did not add to the blood pressure decline.

Combined with the results of previous studies, these new results demonstrate that quitting smoking using e-cigarettes or substantially reducing cigarette consumption using e-cigarettes results in demonstrable improvement in both respiratory and cardiovascular health.

This shatters two major misconceptions of anti-vaping advocates:

1. Electronic cigarettes are a legitimate method of quitting, and they improve health significantly. There is no basis for questioning whether vaping is safer than smoking, and organizations which argue that vaping is more hazardous than smoking or that we are not sure if vaping is any safer than smoking are lying.

2.  Dual use of cigarettes and electronic cigarettes is not necessarily a bad thing. As long as the person cuts down substantially (at a minimum, by greater than half), respiratory and cardiovascular health improvement is observed. While it is obviously much better to quit smoking completely, the claims of anti-vaping advocates that you have to quit completely to experience any health improvement appear to be false.

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