A new study published just days ago in the journal Circulation reported that adults who exclusively use electronic cigarettes experience a 34% reduction in their risk of heart disease.
(See: Berlowitz JB, et al. E-cigarette use and risk of cardiovascular disease: A longitudinal analysis of the PATH study (2013-2019). Circulation 2022; DOI: 10.1161/CIRCULATIONAHA.121.057369.)
The study used a longitudinal design, following approximately 32,000 adults over a six-year period from 2013 to 2019. E-cigarette use and tobacco cigarette use were assessed periodically, as was self-reported heart disease, including a heart attack, heart failure, or stroke. The study examined the risk of incident heart disease for smokers compared to exclusive e-cigarette users, dual users, and nonsmokers, while controlling for age, sex, race/ethnicity, education, body mass index, hypertension, high cholesterol, diabetes, and family history of heart disease.
Compared to nonsmokers, smokers experienced a risk of heart disease that was 1.8 times higher and this difference was statistically significant. Compared to nonsmokers, exclusive e-cigarette users experienced a risk of heart disease that was not statistically different. Thus, the study confirmed a strong link between smoking and heart disease, but did not find any evidence of a link between vaping and heart disease.
Compared to smokers, exclusive e-cigarette users experienced a risk of heart disease that was 34% lower and this difference was statistically significant.
Importantly, the health benefits of switching to vaping were only present for exclusive e-cigarette users. Dual users of both e-cigarettes and cigarettes did not experience any decline in their risk of heart disease.
The Rest of the Story
Public health organizations should be ecstatic about the results of this research. It is ground-breaking research because it provides the first longitudinal assessment of heart disease risk that compares smokers and exclusive vapers. The finding of a 34% decline in heart disease risk among vapers is a game changer. We already knew that vaping was much safer than smoking. However, this is the first time that we have an estimate that quantifies the difference in terms of disease risk. A 34% reduction in heart disease risk is a critically important finding that has major and immediate implications for electronic cigarette policy.
Despite this great news, the American Heart Association chose not to emphasize the tremendous health benefits of quitting smoking and switching to electronic cigarettes. Instead, the American Heart Association headlines seemingly boasted about the finding that dual use had no observed health benefits.
In fact, the headline of the American Heart Association's press release about this study reads: "No health benefits among adults who used both e-cigarettes and traditional cigarettes." Moreover, the press release actually downplayed the finding that vapers experienced a 34% decline in heart disease risk.
The American Heart Association's irresponsible reporting of the results of this study should come as no surprise, as the organization has had a strong bias against vaping for the past decade. It is almost inconceivable to me that the American Heart Association would boast about the lack of health benefits for dual users while nearly ignoring the game changing finding that switching from smoking to exclusive vaping appears to substantially reduce heart disease risk. For an organization whose mission is to reduce heart disease, their actions suggest exactly the opposite desire. The American Heart Association's continued demonization of vaping is - we now know - contributing to an increase, not a decrease, in heart disease because it is discouraging smokers from switching to vaping.
These research findings are critically important because they completely change the picture regarding the FDA's calculus in evaluating pre-market tobacco applications for e-cigarettes. In order to deny applications, the FDA has to conclude that the benefits of introducing the product will outweigh the costs of youth use of the product. This research establishes that the benefits of electronic cigarette use for smokers are immense. It is hard to imagine how this benefit could be outweighed by youth e-cigarette use, with the exception of products that have a high addiction potential, such as those which use nicotine salts or have very high nicotine levels.
At this point, the sound thing for the FDA to do is to simply approve the applications for all products that do not use nicotine salts and do not have nicotine levels above a certain level (for example, 20-24 mg). Unfortunately, it currently appears that the FDA is basically going to deny applications for all pod systems and for all flavors other than tobacco. This will decimate the e-cigarette market, lead to a potentially dangerous black market, and ultimately, increase disease rates by discouraging smokers from switching to vaping and causing many ex-smokers to return to smoking.
This study should cause the FDA to stop everything they are doing and re-assess the balance between the benefits and costs of making vaping products available to adult smokers. Rather than ban 99% of these products, which the agency seems poised to do, it should allow most of these products to remain on the market. However, I believe that the agency should also promulgate a rule that limits the sale of all tobacco and nicotine products to stores that exclusively sell these products and are only open to adults ages 21 and older. This is the best way to balance the risks and benefits of vaping.
Unfortunately, I have little doubt that the FDA will continue with its plan to eliminate 99% of the e-cigarette market. With that plan, they are also going to eliminate tens of thousands of lives.