What are the health risks and treatment options for vaping vs smoking?

Health Risks and Treatment Options for Vaping vs Smoking

Electronic cigarette use or vaping should be discouraged due to its negative effects on cardiovascular and respiratory health, despite being less harmful than traditional combustible tobacco products. 1, 2, 3

Comparative Health Risks

Smoking Risks

• Traditional combustible tobacco products are the most harmful form of tobacco use, associated with well-documented risks of cardiovascular disease, respiratory disease, and cancer 3
• Smoking increases the risk of all types of cardiovascular disease including coronary heart disease, ischemic stroke, and peripheral arterial disease 3
• Smoking combustible cigarettes negatively impacts nearly every organ of the body and reduces life expectancy by approximately 10 years compared to non-smokers 3
• Smoking causes respiratory illness, cancer, cardiovascular disease, and creates a significant tobacco-related health burden 1

Vaping Risks

• Electronic cigarettes and vaping are not harmless alternatives to traditional cigarettes and can adversely affect cholesterol metabolism and cardiovascular health 2
• E-cigarettes contain and emit numerous potentially toxic substances beyond just nicotine, with exposure varying based on product characteristics and usage patterns 3
• Vaping products can contribute to nicotine dependence, confirming there is no safe tobacco product 2
• Health risks associated with vaping affect both cardiovascular and respiratory systems 2, 4
• Vaping solutions and their emissions may contain aerosolized flavorings, propylene glycol, and other intentional and unintentional contaminants that present potential health hazards 4

Special Considerations for Different Populations

Youth and Adolescents

• E-cigarette use among youth poses a clear threat to public health with dramatic increases in usage among young people 3
• E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 3
• Starting at puberty, healthcare providers should screen adolescents and young adults for tobacco, nicotine, electronic cigarettes, substance use, and alcohol use at diagnosis and regularly thereafter 1
• Electronic cigarette use or vaping should be specifically discouraged in youth with diabetes due to increased cardiovascular disease risk 1, 2

Adults with Chronic Conditions

• Individuals with diabetes should be advised to avoid vaping and using e-cigarettes, either as a way to stop smoking tobacco or as a recreational drug 1
• Smoking rates are significantly higher among people with diabetes than those without diabetes, making it important to avoid additional cardiovascular risk factors 1
• Smoking increases the risk of albuminuria onset; therefore, smoking avoidance is important to prevent both microvascular and macrovascular complications 1

Treatment Options for Cessation

Pharmacotherapy

• Varenicline has been found to be the most efficacious pharmacotherapy for people with diabetes when compared with placebo for smoking cessation 1
• Cytisinicline, a plant-based alkaloid that targets nicotinic acetylcholine receptors, has shown efficacy for cessation of e-cigarette use at the end of treatment and was well tolerated by adults seeking to quit vaping 5
• Pharmacotherapy plus counseling improves smoking cessation compared with either pharmacotherapy or counseling alone 3

Behavioral Approaches

• Behavioral strategies should be used to support smoking and vaping cessation to promote optimal health outcomes 1
• Numerous large randomized controlled trials have demonstrated the efficacy and cost-effectiveness of both intensive and brief counseling on smoking cessation 1
• Telephone quit lines and web-based interventions are effective in reducing tobacco use and maintaining abstinence from smoking 1
• For those using e-cigarettes to quit smoking, they should be advised to avoid using both combustible and electronic cigarettes simultaneously, and to develop a plan to eventually quit e-cigarettes as well 2, 3

Clinical Recommendations for Healthcare Providers

• Healthcare providers should incorporate screening for tobacco, nicotine, and electronic cigarette use into routine healthcare visits 1, 2
• Questions for parents that can identify tobacco exposure include asking if the child lives with anyone who uses tobacco, if anyone provides care for the child who smokes, if the child visits places where people smoke, and if anyone smokes in the home or car 1
• When screening for e-cigarette use, providers may need to modify questions to include terms like "vape" or "vaping" and/or use of electronic cigarettes, hookah sticks, e-hookahs, and vape pens 1
• Healthcare providers should recommend that individuals avoid both smoking and vaping for optimal health outcomes 3
• For those who have failed conventional smoking cessation treatments, e-cigarettes used alone for the short term may help quit combustible tobacco, but a plan should be developed to eventually quit e-cigarettes as well 2, 6

Pitfalls and Caveats

• Many people incorrectly perceive e-cigarettes as harmless or significantly less harmful than traditional cigarettes 2
• While vaping may reduce some risks compared to smoking, it is not "the" answer to the public health crisis created by smoking 7
• Weight gain after smoking cessation has been a concern, but studies have found that an average weight gain of 3-5 kg does not necessarily persist long term nor diminish the substantial cardiovascular benefit realized from smoking cessation 1
• Despite the effectiveness of pharmacologic therapy and counseling for smoking cessation, more than two-thirds of people trying to quit do not receive treatment following evidence-based guidelines 1
• Most governing bodies have not approved e-cigarettes as a smoking cessation tool 6