Is electronic cigarette (e-cigarette) use less risky than tobacco smoking?

From the Guidelines

Electronic cigarette (e-cigarette) use is generally considered less risky than tobacco smoking, but it is not risk-free and should be discouraged as a harm-free alternative. The use of e-cigarettes as an alternative to conventional cigarettes should be approached with caution, as they are not harm-free and can deliver higher nicotine contents, as well as emit other constituents such as carbonyls, and fine and ultrafine particulates 1.

Key Points to Consider

• E-cigarettes should only be considered to aid tobacco cessation alongside a formal tobacco cessation programme 1.
• Vaping devices heat a liquid to create an aerosol, avoiding the combustion process that produces many of the harmful chemicals found in cigarette smoke, but still expose users to nicotine and other potentially harmful chemicals 1.
• Individuals with diabetes should be advised to avoid vaping and using e-cigarettes, either as an approach to stop smoking combustible cigarettes or as a recreational drug 1.
• The ideal goal for those trying to quit smoking should be to eventually stop using all nicotine products, and non-smokers, particularly young people, should avoid starting vaping due to the risk of nicotine addiction and potential long-term health effects that are still being studied 1.

Recommendations for Clinical Practice

• Discourage the use of e-cigarettes as a harm-free alternative to conventional cigarettes.
• Consider e-cigarettes as a harm reduction tool for those trying to quit smoking, but only alongside a formal tobacco cessation programme.
• Advise individuals with diabetes to avoid vaping and using e-cigarettes.
• Educate individuals regarding the associated risks of e-cigarette use and provide support for cessation.

From the Research

Comparison of Risks

• Electronic cigarette (e-cigarette) use is often perceived as a safer alternative to tobacco smoking, but the evidence suggests that it is not without risks 2, 3, 4.
• Studies have shown that e-cigarette use can pose health risks, including cardiovascular and respiratory diseases, as well as acute lung injury 4, 5.
• However, some research suggests that e-cigarette use may be associated with a lower magnitude of risk compared to traditional tobacco smoking, particularly in terms of cardiovascular health 5.

Cardiovascular Risks

• E-cigarette use has been linked to adverse cardiovascular effects, including increased blood pressure, tachycardia, and arterial stiffness 5.
• Additionally, e-cigarette use has been associated with an increased risk of adverse clinical events, such as atrial fibrillation and myocardial infarction, although the causal link is still debated 5.

Regulatory Status

• The regulatory status of e-cigarettes varies across the globe, with some countries advocating for their use as a medicinal quit aid, while others have banned them from public spaces 6.
• There is a need for large, long-term global clinical trials to ascertain the potential uses and adverse effects of e-cigarettes and to achieve harmonization of nicotine solution concentration 6.

Harm Reduction

• Some studies suggest that e-cigarettes may have a role in harm reduction, particularly for individuals who are unable to quit smoking traditional tobacco cigarettes 3, 5.
• However, the marketing of e-cigarettes to youth and the lack of regulation and enforcement have led to significant harm, especially in never-smokers who use them 2, 3.