Remember, before COVID-19 took all the oxygen out of the room, when vaping was a big fear. A new study shows what we have claimed all along – vaping reduces inflammatory biomarkers associated with smoking tobacco – writes Dr Chuck Dinerstein for the American Council on Science and Health.
Inhaling combustion products is always a bad idea. Ask a firefighter. So before jumping into this new study, let me be clear: vaping is a gateway to better health for those smoking cigarettes – it is harm reduction, not necessarily elimination, he writes in the 15 January article for the Council, which aims to promote science and debunk ‘junk’. The full article is below:
The research, reported in the journal Circulation, used a study conducted in the United States. The Population Assessment of Tobacco and Health (PATH) was administered in cycles beginning in 2013.
The dataset is from this first cycle using data of participants' smoking habits along with blood samples. The researchers looked specifically at metabolites, biomarkers, of inflammation and oxidative stress – the culprits felt to underlie tobacco's harmful effects.
In addition to the usual demographic data, there was specific information on the use or non-use of tobacco, vaping and cigarette smoking.
Results reflect findings for adults age 18 or older, where data on biomarkers and tobacco use were available – 7,130 participants overall.
- 6% neither smoked nor used e-cigarettes – these are the non-users
- 6% smoked exclusively
- 9% vaped exclusively
- 9% smoked and vaped – dual smokers
- Exclusive and dual smokers had the highest inflammatory and oxidative stress biomarkers relative to nonusers – no surprise there.
- Exclusive vapers had ‘significantly lower levels’ except for C-reactive protein [than smokers, I assume]
While vaping inflammatory biomarkers were elevated compared to non-users, those differences were not statistically significant. There was also no significant difference in the elevation of biomarkers between the exclusive smokers and dual smokers – the additive effect of e-cigarettes was low if present at all.
The bottom line, e-cigarettes appear to have little impact on inflammatory biomarkers, certainly not as great as smoking tobacco. As we have maintained, e-cigarettes reduce harm; we can quibble about eliminating harm another day.
Dual-use smokers are the current target of concern, representing individuals who are ‘failing’ to switch completely or who need those additional hits of nicotine. But this data suggests that regular cigarettes are the primary driver of harm. When it comes to e-cigarettes, perfection is the enemy of good.
We agree with the author's conclusion that these results "…highlight the importance of completely replacing cigarette smoking with e-cigarettes or quitting the use of both products for cigarette smokers to derive potential health benefits."
In a perfect world, we would prefer the latter, but it isn't an ideal world, so in the name of harm reduction, we accept e-cigarette use.
* Dr Charles Dinerstein, MD, MBA, FACS, is the Medical Director at the American Council on Science and Health and has more than 25 years of experience as a vascular surgeon.
To deliver health benefits, vaping must replace smoking – American Heart Association
Two weeks ago, MedicalBrief reported on the American Heart Association finding that smoking traditional cigarettes, as well as using e-cigarettes, results in harmful health effects similar to smoking cigarettes exclusively.
However, the association said in a statement, people who vaped exclusively had significantly lower levels of inflammatory and oxidative stress biomarkers, found the large study of 7,100 adults in the United States.
The results of the research, published on 4 January 2021 in the association’s flagship journal Circulation, could be used by health professionals to counsel patients about the potential risk of using both cigarettes and e-cigarettes.
The article ran the following Introduction to a Research Letter that appeared in Circulation:
Association of Cigarette and Electronic Cigarette Use Patterns With Levels of Inflammatory and Oxidative Stress Biomarkers Among US Adults: Population assessment of tobacco and health study
Andrew C Stokes, Wubin Xie, Anna E Wilson, Hanqi Yang, Olusola A Orimolove, Alyssa F Harlow, Jessica L Fetterman, Andrew P DeFilippis and Emelia J Benjamin
Published in Circulation on 4 Jan 2021
Research letter – Introduction
The cardiovascular toxicity of electronic cigarettes (e-cigarettes) is not well understood, and population data assessing the cardiovascular effects of e- cigarette use are sparse. In the present study, we used nationally representative data to examine the association of cigarette and e-cigarette use behaviours with biomarkers of inflammation and oxidative stress.
Inflammation and oxidative stress are key contributors of smoking-induced cardiovascular disease, and related biomarkers have been studied as predictive factors for cardiovascular events.
The PATH study (Population Assessment of Tobacco and Health) is a nationally representative longitudinal cohort in the United States. The Wave 1 survey was administered from 2013 to 2014 and included the collection of blood and urine samples. Additional information on PATH biospecimen procedures is given elsewhere.
Our analysis was restricted to Wave 1 adults ≥18 years of age with nonmissing data on biomarkers and cigarette/e-cigarette use. Analytic sample sizes were dependent on the respective biomarker considered.
We classified participants into 4 categories based on cigarette/e-cigarette use behaviours in the past 30 days to assess product exposure: (1) Non-use included respondents with no cigarette or e-cigarette use; (2) exclusive e-cigarette included individuals with no cigarette use but e-cigarette use; (3) exclusive cigarette included individuals with cigarette use but no e-cigarette use; and (4) dual use included individuals with e-cigarette and cigarette use.
We selected biomarkers of inflammation (high-sensitivity C-reactive protein, interleukin-6, fibrinogen, soluble intercellular adhesion molecule) and oxidative stress (urinary 8-isoprostane) as dependent variables.
We used the PATH imputed biomarker variables in which observations under the limit of detection were replaced by limit of detection/√2. All biomarkers were right skewed and thus loge transformed for analyses. We adjusted for covariates that may be associated with smoking behaviours or biomarkers of interest.
American Council on Science and Health article – Vaping Reduces Inflammatory Biomarkers, Compared To Smoking
MedicalBrief article – To deliver health benefits, vaping must replace smoking – American Heart Association
American Heart Association statement – Vaping combined with smoking is likely as harmful as smoking cigarettes alone
Circulation journal report – Association of Cigarette and Electronic Cigarette Use Patterns With Levels of Inflammatory and Oxidative Stress Biomarkers Among US Adults: Population assessment of tobacco and health study