Vaping risks significant, says new review

By Dr. Liji Thomas, MDNov 7 2019

Electronic cigarettes (e-cigarettes) are still a very new thing as far as research is concerned. In other words, scientists don’t actually know much about what e-cigarettes do to the body. However, a new review on e-cigarettes and heart health, published in the journal Cardiovascular Health on November 7, 2019, says that these devices have a worrying impact on the cardiovascular system, despite the widespread perception that they are safe.

Image Credit: Aleksandr Yu / Shutterstock

What do e-cigarettes contain?

E-cigarettes are actually electronic devices that fit into the hand comfortably, like a large USB drive, for instance. They have a battery-powered vaporizer, which heats a liquid inside the cartridge to vapor point. This liquid always contains a small amount of nicotine, but may also contain a wide variety of other substances, known and unknown, tested and untested. The difference between cigarettes and e-cigarettes is that while the latter allow some of the behavior typical to smoking, such as moving the device to the mouth, inhaling vapor and exhaling smoke, tobacco is not really burned.

E-cigarettes often contain particulate matter, metals and various synthetic flavorings, cannabinoids, and synthetic cannabinoid-like substances. Any or all of these could cause heart problems, according to researcher Loren Wold, who cites earlier well-established research. For instance, fine particulate matter (sized less than 2.5 microns) is found in polluted air and readily enters the lungs, to enter the bloodstream straightaway, where it can have a direct effect on the heart, stiffens the arteries, and causes inflammation of the whole body. E-cigarette smoke data seem to indicate this risk is real.

The use of these devices has shot up from 7 million in 2011 to more than five times that in just 7 years, at 41 million. By 2021, according to current trends, the number may well go up to 55 million or more – mostly in the US, the UK and France. One in five American teenagers vape, according to 2018 data, accounting for a big share of the almost $ 20 billion global e-cigarette market.  

Vaping hits the heart

Currently available data, though relatively sparse, could support the same findings for e-cigarettes as well. For example, both animals and humans have shown that immediately upon using e-cigarettes, there is a rise in blood pressure, heart rate, arterial stiffness, inflammatory chemicals in the blood, and oxidative molecules such as reactive oxygen and nitrogen species. Any of these, let alone all of them in combination, can cause heart disease over time.

The short-term effects of vaping, or e-cigarette use, are fairly well understood in some areas at least, but the study designs have been quite different. Moreover, there is hardly any knowledge of how long-term e-cigarette use affects health. Calling this latter question “an outright mystery”, Wold says nobody knows how these things will affect the heart.

Unknown danger

The review is valid only for the small subset of vaping products that were studied. Obviously, this should provoke more research, on a larger scale, over a longer period. On the other hand, e-cigarette users should also take notice that these devices are essentially unknown potential dangers. Manufacturers must be required to reveal exactly what each device contains so that users know what poisonous brew they’re going to expose their delicate lungs to. This is especially a matter requiring emergency regulation since vaping products keep changing by the day.

The study’s lead researcher Nicholas Buchanan says there are a whole lot of e-liquids and devices being sold, without any statutory labeling or warning. The vaping illnesses and deaths that are occurring haven’t yet been traced to a single substance. Lack of standardization is hindering diagnosis and treatment, and will prevent solid research in the future as well due to the absence of exposure information for many of the components that are being used. Wold points out, “We cannot assume that ingredients like propylene glycol, glycerine and flavorings, which are inert when ingested orally, have the same effects when inhaled.”

Consider the vaping illnesses that are mystifying America currently. Many of the patients report they smoked e-cigarettes containing tetrahydrocannabinol (THC), or at least they thought they were smoking it. It turns out that in some cases the labels were totally misleading. Moreover, the illness is also reported in some patients who didn’t smoke cannabinoids at all, apparently.

Implications for youth, babies – and second-hand vapers

E-cigarettes have gained a lot of users from two main categories of people: young non-smokers who are attracted by the glamor, apparent safety, and sheer magical variety of sweet and fruity flavors; and smokers who are trying to quit. In the latter case, many have taken to heart the danger of tobacco smoking to the heart, lungs and brain, and the high risk of death with smoking. Unfortunately, many of these switch to vaping as a way to quit, while others taper their cigarette use by partially substituting vaping. But this review casts serious doubt on the validity of this strategy.

Meanwhile, young people are wantonly being exposed to unexpected and unknown risks, quite unnecessarily, since many of them would not otherwise have begun smoking at all. This trend is even more worrying since most of the scanty research on the health impact comes from adults who have already been smoking traditional cigarettes, and deal mostly with the short-term effects of vaping. And with more concentrated e-liquids being used to deliver stronger fumes for a longer period, earlier findings may no longer be accurate.

And it’s not only the millions of youngsters, it’s also the babies in the wombs of mothers who vape, and the many other tens of millions of people who inhale the second-hand smoke from e-cigarettes. Animal studies indicate harm to the offspring during development. Overall, Buchanan says it’s simply not worth the risk at all. “Especially for someone who has never smoked, it seems pretty conclusive that you can say they're not harm-free.”

The European Society of Cardiology emphasizes that international laws must be put in place to prevent the start of an e-cigarette epidemic just as the tobacco epidemic is finally starting to wane just a bit. Wold sums it up: “Adults are beginning to get the message that the full health effects of vaping are unknown, and the risk is potentially very high. My fear is that this has not been crystallized in adolescents.”