Does Vaping Increase Your Risk of Heart Problems?

The use of e-cigarettes has exploded in the last ten years, with some 2.2m people using e-cigarettes or vapourisers. This shift towards “vaping” is expected by some to have health benefits over using tobacco cigarettes, as many of the carcinogens in tobacco and the cigarette’s filter papers are not present in the aerosol mix that vaping provides the user.

A good deal of research confirms the view that switching from tobacco to e-cigarettes does carry net benefits, as we explored on RtH all the way back in 2014.

But vaping is still a new phenomenon. The dangers of tobacco took decades to identify, and required researchers to see the full life cycle of patients who smoke to find links between tobacco smoking and increased risks of lung cancer, cardiovascular disease and many other ailments.

A new study claims to provide some of the first evidence that vaping does possess its own health risks, particularly to the heart. But how can they show this after only 10 years?

What the Researchers Did

The team, led by David Geffen out of the School of Medicine at the University of California Los Angeles, were aware of the limitations of the current data. To link vaping to possible damage to the heart, they looked for symptoms that typically lead to increased “cardiovascular risk”, i.e. the chances that a patient would develop cardiovascular diseases later in life.

They looked at two classes of symptom – “oxidative stress” (essentially an imbalance between oxidising free radicals in the body, and anti-oxidants), and a change in “cardiac autonomic balance” (a measure of the stability of the heart rate).

Both of these phenomena are common in tobacco smokers, and are indicators for later myocardial infarction (heart attack). Generally, high oxidative stress also increases the risk of cancer.

The researchers reason that if these phenomena are associated with vaping, then vaping will also increase the risk of cardiovascular problems like heart attacks later in life.

They therefore studied a sample of 23 participants who were non smokers, but habitual vapers. The participants were otherwise healthy, and ranged from 21 to 45 years old. They were compared against a control sample of 19 participants who neither vaped nor smoked.

The subjects had electrocardiograms taken to measure their cardiac autonomic balance, and blood samples drawn to measure oxidative stress. In both cases, increased ecigarette use was correlated with increased exacerbation of these symptoms.

The authors admit that their study relies on self reporting of both smoking and vaping habits.  They had asked the participants to refrain from vaping a day before the test, but were able to detect cotinine in the blood plasma in several participants (indicating recent tobacco use), and these participants were eliminated from the test.  Previous studies show that smoking tobacco the day before or on the day of measurement can have significant effects.

It also isn’t clear how much vaping is needed to create this increased risk. In smokers, the risk leaps dramatically beyond some threshold number of cigarettes per day, although light use of tobacco is still dangerous. The fact that vapers can control the nicotine flow depending on the equipment they use makes this harder to measure.

Finally, it’s worth noting that this effect is only measured in a sample of 23 (relatively young) people. The statistical significance of some measures is quite weak as a result, so this work needs following up with a much larger study over a longer time period, with a wider sample of people at all ages.

What did the Media say?

I’m pleased to report that the media coverage of this story (at least in the British papers) is on the whole faithful to the original study.

This Metro article gives a fair account of the study, and even gives some handy information on terms like oxidative stress.  Unfortunately, it does not link to the article, and the authors are not reached for comment (although we do applaud their publishing of commentary from the British Heart Foundation).

The Mirror reaches the authors for comment, and also asks the UK Vaping Industry Association (UKVIA) for their thoughts.  They rightly note that tobacco and vaping are not directly compared in the study (although this is not crucial for measuring vaping’s negative effects).  Further, the UKVIA claim that the results are comparable to those achieved by drinking a cup of coffee, or watching a scary film.  It’s interesting to note the cardiovascular risk from a single cup of coffee per day is reduced by drinking slightly more coffee.  It’s unclear at this stage whether vaping will show a similar relationship.

The Sun’s coverage of this story is studded with quotes from a range of scientists (some in the study, some not).  Their piece is informative and wide-ranging – my only concern is the lack of links to the journal article.

The Bottom Line

This study is not the ironclad evidence we are used to for tobacco smoking risks.  That will come once habitual vaping has existed in human populations over an entire generation.  Most evidence suggests that vaping is significantly safer than tobacco smoking, and that switching to vaping poses benefits relative to smoking.

That doesn’t mean vaping is safe.  The vaping industry lacks the regulation given to tobacco smoking.  Studies like this are the first indications that there are possible health risks from vaping, and we will need more research to confirm them.

Like smoking, vaping is a lifestyle choice, just like alcohol and caffeine.  We have to make sensible choices about the risks associated with our diet and general intake.

We know the risks of tobacco, and overconsumption of alcohol.  The benefits and risks of vaping are becoming clearer as studies like this emerge.  This information is crucial for helping us regulate vaping products, and finally for customers to make informed choices about what they choose to buy.