What are the health risks associated with electronic cigarette (e-cigarette) use?

From the Guidelines

Vaping poses significant health risks and should be discouraged due to its potential to cause harm to the cardiovascular and respiratory systems, as well as its highly addictive nature. The use of electronic cigarettes (e-cigarettes) has been linked to negative changes in vascular endothelial function, and evidence suggests that acute inhalation of e-cigarettes can lead to increased cardiovascular risk 1. Furthermore, e-cigarettes contain nicotine, which is highly addictive and can harm adolescent brain development, impact learning, and cause mood disorders. The aerosol produced by e-cigarettes also contains harmful substances, including ultrafine particles, volatile organic compounds, heavy metals like nickel and lead, and cancer-causing chemicals.

Health Risks Associated with Vaping

• Cardiovascular problems, including increased heart rate and blood pressure
• Potential long-term respiratory issues
• Serious lung injuries (EVALI)
• Cancer-causing chemicals
• Ultrafine particles, volatile organic compounds, and heavy metals like nickel and lead

Alternatives to Vaping for Smoking Cessation

• FDA-approved nicotine replacement therapies, such as patches (21mg/24hr, 14mg/24hr, 7mg/24hr), gum (2mg or 4mg), lozenges
• Prescription medications like varenicline or bupropion under medical supervision
• These alternatives have established safety profiles and effectiveness data, making them a better choice for smoking cessation than vaping 1.

Recommendations

• Individuals with diabetes should be advised to avoid vaping and using e-cigarettes, either as a way to stop smoking combustible cigarettes or as a recreational drug 1.
• If people are using e-cigarettes to quit, they should be advised to avoid using both combustible and electronic cigarettes, and if using only e-cigarettes, they should be advised to have a plan to quit these also 1.
• The use of e-cigarettes should only be considered to aid tobacco cessation alongside a formal tobacco cessation programme, and patients should be warned about the risks of developing long-term dependence 1.

From the Research

Vaping Risks

• The use of electronic cigarettes (e-cigarettes) has been associated with several health risks, including respiratory and cardiovascular diseases 2, 3.
• The 2019 E-cigarette or Vaping Use-Associated Lung Injury (EVALI) outbreak highlighted the potential harms of vaping, and the consequences of long-term use remain unknown 2.
• Vaping has been linked to acute lung injury, and the underlying cause remains unknown 3.
• The pulmonary risks of vaping are rapidly emerging, with the most immediately alarming being the condition electronic-cigarette/vaping associated lung injury (EVALI) 4.
• Extrapulmonary effects of vaping include cardiovascular, immunologic, and neuro-developmental effects, many of which are likely dose-dependent 4.

Health Impact on Adolescents and Young Adults

• Adolescents are vulnerable to the risks of e-cigarettes, as they are targeted as new consumers with advertisements and flavoring compounds, and are not utilizing them as a means to smoking cessation 4.
• The use of e-cigarettes is exploding among the pediatric population, with over 40% of high school seniors reporting use within the past year 4.
• Public health efforts are urgently needed to decrease or eliminate new e-cigarette initiation, and support should be established to assist current e-cigarette users with cessation 4.

Regulation and Policy Initiatives

• A comprehensive approach for harm reduction to the vaping epidemic is imperative, including product warnings and regulation, public media campaigns, economic and social strategies, and policy initiatives 5.
• The elimination of e-cigarette flavorings and advertising directed at adolescents is strongly advocated for 4.