Comparative Health Risks of Smoking and Vaping

Introduction to Health Risks

• The American College of Cardiology states that smoking combustible cigarettes negatively impacts nearly every organ of the body and reduces life expectancy by approximately 10 years compared to non-smokers 1
• The American College of Cardiology reports that smoking is the leading cause of preventable mortality and morbidity worldwide 1
• According to the American College of Cardiology, globally, smoking and exposure to secondhand smoke are responsible for roughly 1 in 5 (21%) of all deaths attributed to coronary heart disease 1
• The European Heart Journal found that smoking increases the risk of all types of cardiovascular disease including coronary heart disease, ischemic stroke, and peripheral arterial disease 2
• The European Heart Journal states that the relative risk of myocardial infarction in smokers under 50 years is five-fold higher than in non-smokers 2

Vaping-Related Health Risks

• The American College of Cardiology notes that e-cigarettes contain and emit numerous potentially toxic substances beyond just nicotine, though exposure is highly variable based on product characteristics and usage patterns 1
• The American College of Cardiology states that compared with combustible tobacco cigarettes, e-cigarette use likely poses less risk, but is not harmless 1, 3
• The American College of Cardiology reports that growing evidence shows e-cigarettes and their constituents can have deleterious effects on the cardiovascular system, respiratory system, and brain 1, 4

Special Considerations for Youth and Dual Use

• The American College of Cardiology found that e-cigarette use among youth poses a clear threat to public health with dramatic increases in usage among young people in the United States 1
• The American College of Cardiology states that e-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents who had no previous intention of smoking conventional cigarettes 1
• The American College of Cardiology notes that the introduction of high-nicotine delivery systems has transformed the e-cigarette landscape and increased addiction potential for young people 1
• The Forum of International Respiratory Societies recommends that individuals using e-cigarettes to quit smoking should avoid using both combustible and electronic cigarettes simultaneously 5

Smoking Cessation Considerations

• The American College of Cardiology states that evidence is limited regarding the efficacy of e-cigarettes as a smoking cessation aid 1
• The American College of Cardiology reports that a 2020 Cochrane review found only moderate evidence that quit rates were higher among those using nicotine e-cigarettes compared with nicotine replacement therapy or non-nicotine e-cigarettes 1
• The European Respiratory Review found that pharmacotherapy plus counselling improves smoking cessation compared with either pharmacotherapy or counselling alone 6
• The American Journal of Respiratory and Critical Care Medicine states that stopping smoking increases life expectancy at any age - those who quit at 30, 40, or 50 years gain about 10, 9, and 6 years of life expectancy, respectively, compared with continued smokers 7
• The US Preventive Services Task Force recommends focusing on proven behavioral counseling and FDA-approved pharmacotherapy for smoking cessation rather than e-cigarettes 8

Clinical Recommendations for Healthcare Providers

• The American College of Cardiology advises healthcare providers to recommend that individuals avoid both smoking and vaping for optimal health outcomes 1
• The Forum of International Respiratory Societies recommends that healthcare providers advise patients using e-cigarettes to quit smoking to avoid dual use and develop a plan to eventually quit e-cigarettes as well 5
• The US Preventive Services Task Force recommends that healthcare providers incorporate screening for tobacco, nicotine, and electronic cigarette use into routine healthcare visits 8

Health Risks and Clinical Guidance on Vaping

Cardiovascular Risks

• E‑cigarettes cause documented harm to the cardiovascular system despite being marketed as safer alternatives to combustible cigarettes, warranting avoidance in all patients. 9
• Individuals with diabetes should specifically avoid vaping because nicotine‑induced cardiovascular injury adds to their already elevated risk of heart disease. 9

Nicotine Addiction and Gateway Effects

• E‑cigarettes are highly addictive and act as a gateway to combustible‑cigarette use, especially among youth. 9
• The Population Assessment of Tobacco and Health (PATH) study confirms that e‑cigarette use leads to nicotine dependence and that no tobacco product can be considered safe. 9

Toxic Substance Exposure (Second‑hand)

• Adverse health effects for by‑standers exposed to e‑cigarette emissions cannot be excluded, indicating a potential risk to non‑users. 10, 11

Special Population: Diabetes

• The American Diabetes Association recommends that people with diabetes avoid e‑cigarettes both as a smoking‑cessation aid and for recreational use. 9

Dual Use Amplifies Risk

• Patients who use e‑cigarettes to quit smoking should be counseled to stop using both products simultaneously and to develop a concrete plan to discontinue e‑cigarette use. 9

Clinical Recommendations for Smoking Cessation

• Varenicline, combined with counseling, should be offered as first‑line pharmacotherapy for smoking cessation rather than e‑cigarettes. 9

Misconceptions About Safety

• Marketing and popular press have created false perceptions that e‑cigarettes are harmless, a misconception supported by evidence of health risks. 10, 11
• While combustible tobacco products remain the most harmful, electronic nicotine delivery systems should not be characterized as harmless. 9
• The long‑term health risks of e‑cigarettes remain uncertain because they have not been adequately studied. 10, 11
• The addictive power of nicotine and its adverse health effects should not be underestimated. 10, 12, 13