E-Cigarettes: No Definitive Evidence on Their Potential Cardiovascular Effect, but Some Suggest Caution

E-cigarettes may bring about cardiac risk according to a new literature review soon to be published in J Am Coll Cardiol. The evidence on potential harm is not definitive, but some experts suggest caution in their use until there is more solid evidence.

E-cigarettes have been advertised as a healthy alternative to traditional cigarettes and an aid for tobacco cessation, but recent evidence suggests that they might cause adverse cardiovascular events.

Such events involve endothelial function, vascular stiffness, vasoconstriction, heart rate, blood pressure, inflammation, oxidative stress, and platelet function (all of which have already been observed with e-cigarettes). While e-cigarettes are widely believed to be safe (in terms of both cardiovascular risk and cancer), the truth is that they have not been studied enough. In fact, we could say that there is not enough solid evidence confirming that e-cigarettes even help people to quit smoking conventional cigarettes.

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These devices can only be considered another tool to help people quit smoking.

If they do help smokers to quit conventional cigarettes, their potential for public health benefit is huge. However, this potential benefit must be balanced against their long-term health risks, which are still unknown.

Researchers reviewed 14 studies (all of them carried out in developed countries) that suggest possible cardiovascular harm and note that e-cigarettes are available in most countries around the world without any regulation.

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We have a responsibility to inform our patients that e-cigarettes contain chemicals whose long-term effects are currently unknown. For smokers, this may be the lesser evil, but we should emphasize the fact that we still lack enough evidence.

Original title: 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment.

Reference: Barua RS et al. J Am Coll Cardiol. 2018; Epub ahead of print.

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