Your Weekly Checkup: Are Electronic Cigarettes Safer?

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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Electronic cigarettes, invented and patented only 15 years ago, have surged to prominence with predicted sales in the billions of dollars. They are designed to deliver nicotine as an aerosol that simulates smoking without real smoke. E-cigs consist of a mouthpiece, a liquid-filled cartridge containing concentrated flavors and variable amounts of nicotine, an aerosolizing component, and a battery-powered heater that converts the liquid into vapor mimicking cigarette smoke. Used cartridges can be replaced or refilled and are good for about 150–300 puffs, compared to 10–15 puffs in a single conventional cigarette.

Whether e-cigs reduce the number of cigarette smokers currently about 37 million Americans — or create more smokers than quitters is controversial. E-cig smokers may be merely substituting one form of nicotine addiction for another. A study that just published found that participants using e-cigarettes were less likely to quit smoking after six months compared with those who did not use e-cigarettes.

Manufacturers have claimed e-cigs are safer than traditional cigarettes because they do not burn tobacco or expose users to the known toxic chemicals in tobacco smoke, which is the component primarily responsible for tobacco-attributable harm. However, the FDA has prohibited manufacturers from marketing that statement, reporting that e-cigarette cartridges and solutions contain nitrosamines, diethylene glycol, and other contaminants potentially harmful to humans [PDF]. A recent study found many of the volatile organic compounds identified in e-cigs to be carcinogenic. Significant levels of highly toxic arsenic, chromium, manganese, nickel, and lead have also been found.

In January 2018, an expert committee of the National Academies of Sciences, Engineering, and Medicine concluded, “There is no available evidence whether or not e-cigarette use is associated with clinical cardiovascular outcomes (coronary heart disease, stroke, and peripheral artery disease) and subclinical atherosclerosis (carotid intima media-thickness and coronary artery calcification).” They did note that heart rate increased after e-cig nicotine exposure, while a recent report found that blood pressure also rose acutely after e-cig exposure.

My conclusion at the present time is that vaping may be safer than traditional smoking, but we need more studies to be sure. Nicotine is addicting, whether in an e-cig or conventional cigarette. The safest recourse is not to smoke. Period!