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The Risks and Reality of Vaping

December 11, 2023 from Medscape


In a recent 2023 American Heart Association Scientific Statement, Dr. Neil Skolnik delves into the cardiopulmonary implications of electronic cigarettes and vaping. The introduction of vaping products to the United States took an unexpected turn as the FDA’s attempt to classify them as drug delivery devices faced legal challenges.


In 2010, the court ruled in favor of the vaping industry, leading to an unexpected rise in popularity. Alarming statistics reveal that high school students’ use of vaping has skyrocketed from 1% in 2011 to a current range of 10%-20% over the past four years, surpassing traditional cigarette use among youth.


Electronic Nicotine Delivery Systems (ENDS) serve as the scientific term encompassing both e-cigarettes and vaping products. These systems involve a heating coil that vaporizes a fluid containing propylene glycol, glycerol, nicotine, and various flavorings. Tetrahydrocannabinol (THC) is also commonly added. The resulting aerosolized vapor, inhaled by users, forms the basis of vaping.


Dr. Skolnik breaks down the constituents of vaping fluids and their individual and combined effects on the cardiovascular and respiratory systems. Nicotine, the primary psychoactive component, exhibits sympathomimetic effects, potentially leading to cardiac remodeling and increased susceptibility to arrhythmias. Propylene glycol and glycerol show emerging evidence of direct cardiopulmonary effects, causing symptoms like wheezing and throat irritation.


Flavorings, sweeteners in particular, contribute to cardiovascular disease and Chronic Obstructive Pulmonary Disease (COPD). The release of nickel and chromium from the heating element poses risks of pneumonitis and pulmonary inflammation. Vaping, whether nicotine-containing or not, can increase platelet activation, vascular stiffness, and reactive oxygen species while decreasing brain glucose utilization.


While most known adverse effects are short-term due to the relatively recent introduction of e-cigarettes, animal models suggest potential long-term risks. Oxidative stress, inflammation, and DNA damage observed in these models raise concerns about increased risks for COPD and lung cancer. Additionally, vaping has been linked to E-cigarette or Vaping-Associated Lung Injury (EVALI), resulting in 2,807 hospitalizations and 68 deaths throughout 2020. Symptoms include fatigue, fever, respiratory distress, and a distinct ground-glass appearance on chest x-rays.


Dr. Skolnik’s statement addresses the common question of whether vaping can aid in smoking cessation. While not FDA approved for this purpose, a Cochrane analysis indicates that nicotine-containing vaping products may be approximately 50% more effective than nicotine replacement therapy.


The accumulating evidence suggests that vaping is not a benign activity, and the potential for adverse impacts to accumulate over time should not be dismissed. The physiological effects of vaping mirror early findings associated with cigarette smoking, emphasizing the importance of public awareness and regulatory scrutiny in mitigating potential health risks.





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