Health Risks of Shisha and E-Cigarettes

Introduction to Health Risks

• The American College of Cardiology and JAMA recommend that both shisha and e-cigarettes be avoided entirely, as neither is a safe alternative to smoking, and proven smoking cessation methods should be used instead 1, 2

Cardiovascular Risks

• Nicotine from any source, including e-cigarettes and shisha, contributes to coronary artery disease, atherosclerosis, and aortic aneurysms, according to the American Journal of Respiratory and Critical Care Medicine 4
• E-cigarettes cause deleterious cardiovascular effects through nicotine, vaporizing solvents, particulate matter, metals, and flavorings, as reported by the American College of Cardiology 1, 3

Respiratory Risks

• E-cigarettes contain and emit numerous potentially toxic substances beyond nicotine, with highly variable exposure based on product characteristics, according to the American College of Cardiology 1, 3

Smoking Cessation

• The American College of Cardiology and JAMA recommend behavioral counseling combined with FDA-approved pharmacotherapy as the proven approach for smoking cessation 2, 6
• Varenicline is the most efficacious pharmacotherapy, including for people with diabetes, as reported by Diabetes Care 6
• Pharmacotherapy plus counseling improves cessation rates compared to either alone, according to the European Respiratory Review 7

Clinical Guidance

• The American College of Cardiology and JAMA advise against recommending e-cigarettes as a first-line cessation tool, as they lack the evidence base of approved pharmacotherapies 1, 2, 6
• Screen specifically for all tobacco products, including shisha and e-cigarettes, at routine visits, as recommended by Diabetes Care and the American College of Cardiology 6