Comparative Health Risks of Vaping versus Cigarette Smoking
Both vaping and cigarette smoking pose significant health risks, but smoking combustible cigarettes is more harmful overall, reducing life expectancy by approximately 10 years compared to non-smoking. 1, 2
Key Comparative Health Risks
Smoking combustible cigarettes negatively impacts nearly every organ system in the body and is the leading cause of preventable mortality and morbidity worldwide, with smoking and secondhand smoke responsible for roughly 1 in 5 deaths attributed to coronary heart disease 1, 2
Electronic cigarettes (e-cigarettes) and vaping are not harmless alternatives to traditional cigarettes and can adversely affect cholesterol metabolism and cardiovascular health 1, 3
Nicotine, present in both cigarettes and most e-cigarettes, has significant cardiovascular effects and may contribute to the development of coronary artery disease, atherosclerosis, and aortic aneurysms 2, 3
Cigarette smoking is associated with increased susceptibility to and severity of respiratory infections through mechanisms including immune suppression and physical changes such as abnormal ciliary function 4
Combustion products of tobacco smoke induce oxidative stress, promote inflammation and vascular injury, and establish a prothrombotic state that could contribute to increased disease severity 4
Vaping-Specific Concerns
E-cigarette aerosols contain more than just nicotine, including aerosolized flavorings, propylene glycol, and other intentional and unintentional contaminants that may present undefined potential health hazards 5
Vaping aerosols are not benign, especially for nearby people in areas with limited ventilation and people with compromised health conditions 5
The 2019 outbreak of e-cigarette or vaping product use-associated lung injury in the United States led to over 2,800 hospitalizations, highlighting potential acute risks of e-cigarettes and vaping products 6
E-cigarettes and vaping products do not undergo the premarket animal and human safety studies required of drug products or medical devices, as they are regulated as tobacco products 6
Smoking Cessation Considerations
Evidence is limited regarding the efficacy of e-cigarettes as a smoking cessation aid 2
Recent research suggests that neither daily nor nondaily vaping was associated with increased smoking cessation, and each was associated with reduced tobacco abstinence 7
Pharmacotherapy plus counseling improves smoking cessation compared with either pharmacotherapy or counseling alone 1
The US Preventive Services Task Force recommends focusing on proven behavioral counseling and FDA-approved pharmacotherapy for smoking cessation rather than e-cigarettes 2
Special Population Considerations
The American Diabetes Association recommends that individuals with diabetes avoid vaping and using e-cigarettes, either as a way to stop smoking tobacco or as a recreational drug, due to increased cardiovascular disease risk 1, 3
E-cigarette use among youth poses a clear threat to public health with dramatic increases in usage among young people 1, 2
E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 2
Clinical Recommendations
Healthcare providers should recommend that individuals avoid both smoking and vaping for optimal health outcomes 1, 2
If people are 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
Screening for tobacco, nicotine, and electronic cigarette use should be incorporated into routine healthcare visits 1, 3
For those attempting to quit smoking, evidence-based approaches including behavioral counseling and FDA-approved pharmacotherapies should be recommended rather than e-cigarettes 1, 2
Common Pitfalls and Caveats
Many people incorrectly perceive e-cigarettes as harmless or significantly less harmful than traditional cigarettes 1, 3
Despite marketing claims, e-cigarettes are not a proven safe alternative to combustible cigarettes and carry their own health risks 2, 8
Weight gain after smoking cessation has been a concern, but studies have found that an average weight gain of 3-5 kg does not diminish the substantial cardiovascular benefit realized from smoking cessation 1
The long-term health effects of e-cigarettes and vaping products are still not fully understood, as these products have only been widely available for about a decade 9, 6