Current Evidences on New American Heart Association Reveals the Health Hazards Associated with the Use of E-cigarettes, Highlighting the Urgent Need for Further Research into their Long-term Impact
Man-blowing e-cigarette smoke - vaping
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Video of a man, woman, and teen smoking an e-cigarette.
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To fully comprehend the implications of e-cigarette use, extensive clinical studies are required to explore the long-term effects on the heart, blood vessels, and lungs. Additionally, experts stress the importance of molecular and laboratory research to shed light on the biological consequences of using e-cigarettes while long-term studies are being conducted.
Released on July 17, 2023, the American Heart Association's scientific statement sheds light on the growing body of evidence linking e-cigarette use to health risks, particularly in relation to cardiovascular and respiratory health. Titled "Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products," the statement presents up-to-date usage data, identifies current health impacts, and emphasizes the need for comprehensive research to understand both short-term and long-term health effects associated with e-cigarette use.
E-cigarettes, or vaping products, are battery-operated devices that heat a liquid solution, known as e-liquid, generating an aerosol that is inhaled into the lungs. Most e-liquid formulations contain nicotine, a substance known to have negative health consequences and strong addictive properties. In addition to nicotine, these products can also contain tetrahydrocannabinol (THC), the psychoactive component of cannabis, as well as methamphetamine, methadone, vitamins, humectants (such as propylene glycol and vegetable glycerol) that act as solvents, flavoring agents, cooling agents like menthol, sweeteners, and trace amounts of metals from the heating coil.
Dr. Jason J. Rose, the volunteer chair of the scientific statement writing committee and an associate professor of medicine at the University of Maryland School of Medicine, highlights the potential harm caused by the multitude of substances delivered into the body through e-cigarette use. These substances, including chemicals and compounds that users may not be aware of or understand, have been associated with acute changes in various hemodynamic measures such as increased blood pressure and heart rate. Moreover, research indicates that even in the absence of nicotine, e-cigarette ingredients, particularly flavoring agents, independently pose risks to heart and lung health in animal studies. Negative effects of e-cigarettes have also been observed in in vitro studies and studies involving individuals exposed to commercially available products.
The scientific statement emphasizes the significance of the clinical diagnosis known as "E-cigarette, or Vaping, product use Associated Lung Injury" (EVALI), which was first identified by the U.S. Centers for Disease Control and Prevention in 2019. Within a span of less than a year, approximately 2,800 e-cigarette users were hospitalized due to EVALI. This serves as a stark reminder of the limited understanding surrounding the risks associated with e-cigarettes and their ingredients. In the case of EVALI hospitalizations, vitamin E acetate, a thickening agent used in certain e-cigarette liquids, has been implicated as the likely cause of illness.
Although there is limited research on the specific impact of e-cigarettes on heart attacks and strokes, much of the existing studies have been conducted on individuals who have used or currently use traditional cigarettes. Furthermore, large-scale survey studies have primarily focused on younger adults who have a low incidence of heart attacks and strokes. To comprehensively assess the effects of e-cigarette use, including among individuals with pre-existing cardiopulmonary conditions like coronary artery disease or chronic obstructive pulmonary disease, it is imperative to conduct long-term studies involving e-cigarette users of all age groups, including those with existing cardiovascular disease.
Recent analysis of the adult Population Assessment of Tobacco and Health (PATH) study found a statistically significant association between former or current e-cigarette use and the development of respiratory diseases, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, or asthma, within two years of enrollment. The PATH study, initiated in 2013, represents one of the primary tobacco research efforts undertaken by the National Institutes of Health and the U.S. Food and Drug Administration.
Additional studies referenced in the statement highlight a rapid increase in the number of individuals who have used or currently use e-cigarettes since 2010. Most of these users were either current or former traditional cigarette smokers. Notably, data from the Behavioral Risk Factor Surveillance System in 2016 indicated that approximately 1.2 million adults in the United States who had never smoked combustible cigarettes were using e-cigarettes.
The writing committee also underscores the prevalence of e-cigarette use among young people, particularly high school and middle school students. Data cited in the statement reveals that almost three out of four young e-cigarette users exclusively use flavored e-cigarette products. Given the high rate of youth consumption, it is crucial to evaluate both short-term and long-term health effects associated with these products.
The appeal of e-cigarette flavors often attracts young individuals, leading to nicotine dependence. There is a significant concern that young people perceive e-cigarettes as harmless due to their wide availability and targeted marketing towards their age group, many of whom have never used any tobacco products. The long-term risks of e-cigarette use remain unknown, but if the risks of chronic use are similar to or even reduced but still present compared to combustible cigarettes, the full extent of these risks may not become apparent for decades. Additionally, studies indicate a correlation between e-cigarette use and substance use disorders, as some youth who use e-cigarettes are more likely to also use other tobacco products.
Given the well-established health risks associated with smoking combustible cigarettes, e-cigarette products have been evaluated as potential smoking cessation tools. However, after examining the limited research in this area, the writing committee concluded that any potential benefits of e-cigarettes in smoking cessation must be carefully weighed against the known and unknown health risks, including the risk of long-term dependence on these products.
Dr. Rose Marie Robertson, the deputy chief science and medical officer of the American Heart Association, and co-director of the Association's Tobacco Center of Regulatory Science, emphasizes that there is no strong evidence to support the claim that e-cigarettes are an effective way to quit smoking traditional cigarettes, beyond potential short-term benefits. The lack of long-term safety data on e-cigarette use, coupled with the observed addiction to e-cigarette products among young people, are among the reasons why the American Heart Association does not endorse the use of e-cigarettes for smoking cessation. It is important to note that e-cigarette products are not approved by the U.S. Food and Drug Administration (FDA) for tobacco cessation. The Association recommends a combination of multi-episode cessation counseling, personalized nicotine replacement therapy with FDA-approved doses and formulations, as well as medications to manage cravings, as the preferred approach to help individuals who smoke combustible cigarettes quit. Furthermore, it is essential to understand that quitting smoking often requires multiple attempts, and setbacks should be viewed as learning opportunities on the path to overcoming a powerful addiction permanently.
The scientific statement writing committee underscores the critical need for further research and knowledge in the following areas: • Future research should prioritize gaining a deeper understanding of the serious and potentially long-term effects of e-cigarettes on the heart, blood vessels, and lungs. • Studies should include patients with pre-existing cardiopulmonary conditions, such as coronary artery disease or chronic obstructive pulmonary disease, to evaluate and compare outcomes among e-cigarette users, traditional smokers, dual users (those who use both e-cigarettes and traditional cigarettes), and nonsmokers. • Thorough research is necessary to explore the effects of common chemical ingredients in e-cigarettes independently on pulmonary and cardiac health. • Clinical studies are essential to examine the risks and potential benefits of e-cigarettes as alternatives to traditional combustible cigarettes. • Given that the long-term health impact of e-cigarettes may take several decades to manifest, molecular and laboratory studies are crucial in the interim to determine the biological implications of e-cigarette use.
As e-cigarettes and vaping systems have only been in use in the United States for approximately 15 years, there is currently insufficient data on their long-term health effects. Consequently, shorter-term studies, molecular experiments, and animal research are relied upon to assess the true risk associated with e-cigarette use. However, it is imperative to expand this type of research due to the exponential growth of e-cigarette adoption, particularly among young individuals who may have never used traditional combustible cigarettes.
The scientific statement was prepared by a volunteer writing group on behalf of various councils of the American Heart Association, including the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; the Council on Epidemiology and Prevention; the Council on Cardiovascular Radiology and Intervention; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; the Stroke Council; and the Council on Arteriosclerosis, Thrombosis, and Vascular Biology. Scientific statements from the American Heart Association serve to raise awareness about cardiovascular diseases and assist in making informed healthcare decisions. While scientific statements inform the development of guidelines, they do not provide treatment recommendations.
The primary source of funding for the American Heart Association comes from individual donations. Additionally, foundations and corporations, including pharmaceutical and device manufacturers, contribute donations and support specific programs and events. Strict policies are in place to ensure that these relationships do not influence the scientific content. The Association's financial information, including revenues from pharmaceutical and biotech companies, device manufacturers, and health insurance providers, can be found in their publicly available records.
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