E-cigarettes: Where there's No Smoke, there's Still Fire

Habitual E-cigarette Use Elevates CV Risk.

Habitual use was associated with a shift in cardiac autonomic balance toward sympathetic predominance and increased oxidative stress in a cross-sectional case-control study of habitual e-cigarette users and nonuser controls, aged 21-45 years. Both are associated with increased cardiovascular risk.

No END in Sight.

While the prevalence of tobacco smoking has been declining, the use of electronic nicotine delivery systems (ENDS)-e-cigarettes, vaporizers, hookahs-has been rising, especially among adolescents. Youths often perceive ENDS as safe, but nicotine exposure may have deleterious effects on the developing brain and ENDS may be a “starter” drug that may lead to further tobacco, drug, or alcohol use.

Depressing Findings.

E-cigarette use did not predict elevated depressive symptoms in a study of college students in Texas, but depressive symptoms predicted e-cigarette use. Additional research was recommended to further establish the mechanisms for causality.

E-Cigarettes and “Dripping.”

About 1 in 4 high school adolescents who had ever used e-cigarettes also reported using them to inhale vapors produced by dripping e-liquids directly onto heated atomizers. Reasons for dripping: “produced thicker clouds of vapor” (63.5%), “made flavors taste better” (38.7%), “produced a stronger throat hit” (27.7%), and “curiosity” (21.6%). Study authors called for examination of the progression and toxicity of dripping and for educating youths about potential dangers.

Nicotine, but with Fewer Toxins.

Not all of the latest findings about e-cigarette use are gloomy. Former combustible cigarette smokers with long-term e-cigarette–only or nicotine replacement therapy (NRT)–only use may obtain levels of nicotine roughly similar to those obtained by smokers of combustible cigarettes only. However, long-term NRT-only and e-cigarette–only use is associated with substantially reduced levels of measured carcinogens and toxins.

E-cigarette Answers for Patients.

French medical experts developed practice guidelines for managing e-cigarette smoking and providing information to answer patients’ questions: (1) E-cigarette risks are much lower than tobacco risks. (2) A dual user is at high risk for returning to exclusive tobacco use. (3) A smoker who wants to use e-cigarettes to quit smoking should be encouraged. (4) A vaper who is tired of vaping should be encouraged to quit. Specific guidelines are provided for various patient subgroups