Once again, there is a headline sweeping the UK media channels – both print and radio – that is not only misleading, but is also downright dangerous. Many of the UK papers have led with the headline “Vaping is as bad as SMOKING”, which regular readers of this blog will know is simply not true. Vaping may indeed not be entirely risk free, but there are very few things (if any) in this world that are risk free. I suppose you could say, the greater the pleasure the greater the risk – but that doesn’t apply to vaping, it’s always been the odd one out really.
Unlike a previous headline where the media boldly claimed that vaping has adverse effects on the cardiovascular system, which was indeed based on a study, today’s headlines spring from nothing more than a letter to the editor. Points for who can remember what other “letter to the editor” sprung a host of ridiculous headlines. However, thanks to technology I have a copy of said letter, so let’s have a look shall we?
Smoking increases aortic stiffness and blood pressure (BP) which are both important predictors of cardiovascular risk and all-cause mortality.
First up, smoking increases aortic stiffness and blood pressure. Truth there I’m afraid, but what else causes such a biological response? Well, drinking coffee (or tea) would. So would watching a horror/suspense movie, or high intensity resistance training. For some listening to Justin Bieber would do the trick, as would being involved in any highly charged spectating (such as a World Cup final for instance). Yet none of these are listed to be “as bad as smoking” are they? These are perfectly normal (with the exception of listening to Bieber) activities for the majority of most populations.
Electronic cigarettes (EC) simulate tobacco cigarettes (TC) and have been advocated as a less harmful alternative.
Well that’s part of the reason why vaping works dummy. The ritualistic motions of the hand-to-mouth action, coupled with the wide variety of devices, customisation, and of course flavours create a completely different association than tobacco smoking. Plus, if you bother to read either the PHE Evidence Update or the Royal College of Physicians report, they’ll come across my favourite quote:
Although it is not possible to quantify the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.
It’s hard to argue with such a statement isn’t it? Considering the vast majority of “science” that emanates from the US is utter bunkem and adds nothing but confusion to the debate.
The effect of EC on aortic stiffness has not been defined. We investigated the acute effects of EC smoking on aortic stiffness and BP and compared them with the effects of TC smoking.
Actually it has been investigated, and found wanting as Professor Siegel has scrutinised the initial paper from April, as has Clive Bates. In both cases, everyone’s favourite airplane mechanic has (badly) written a short blog summarising why he ‘thinks’ each study is “important”. Maybe it is important to help fund his mortgage, who knows, but it isn’t really important in the context of harm reduction.
We studied 24 smokers (age: 30 +/- 8 years) otherwise free of cardiovascular risk factors on 4 separate occasions (total 96 sessions): 1) TC over 5 min; 2) EC over 5 min; 3) EC for a period of 30 min; and 4) nothing (sham procedure) for 60 min.
Ah, so there is an actual study, it just hasn’t been published yet – this has all come about from a conference abstract, where the author(s) released their initial findings – as is the norm for the US, though it is becoming common elsewhere. It’s the old “publish or perish” mantra.
Thing is, this is where they start to go wrong.
EC5 min was chosen as a direct comparison with TC (nicotine delivery rate from EC is far lower and slower than with TC), and EC30 min to mimic the common pattern of EC smoking (nicotine delivered obtained plasma levels comparable with those after 5 min of TC smoking)
Most of the time when I smoked a cigarette wouldn’t last 5 minutes, unless I was in the process of doing something else and, as far as I know not one vaper uses his or her device for 30 minutes straight.
There were no differences in all baseline measurements between the sessions. Heart rate increased in both the TC and EC 30-min sessions (by 4.0 beats/min after 5 min and by 3.1 beats/min after 30 min, respectively), whereas the effect of EC5 min smoking on heart rate was minimal.
Nicotine delivery is the common characteristic of e-cigarette use and cigarettes – and both smokers and vapers are trying to obtain an equivalent hit, and therefore we might expect nicotine exposure to be roughly similar. It follows that any effects on the body arising from nicotine exposure are likely to be similar. So if we are looking for a common explanation for the similar findings for smoking and vaping being similar, nicotine exposure is the obvious place to start, given nothing else is remotely similar, and we know stimulants like caffeine have an effect.
As with any e-cigarette study from the US, the researchers always take the “worst” sample. In this case, comparing a 5-minute smoking session to a 30-minute vaping session by saying that both increased heart-rate – which we already knew as nicotine (like caffeine) is a mild stimulant. Oddly enough, the researchers make little or no mention of the recorded heart-rate after the EC5min session, they only mention its effect as being “minimal”. They even go as far as saying some of the effects of EC5min are not significant:
Mind you, there is clear confusion as the authors refer to vaping as “EC smoking” throughout the letter – no doubt that is deliberate – plus there is also their closing “recommendations” :
Given the prognostic role of aortic stiffness and increased BP for future cardiovascular events and mortality, as well as the prolonged exposure to EC smoking throughout the day matched with the strong tendency of this form of smoking to spread worldwide, especially within younger ages, our findings have important implications that could aid recommendations regarding the use of EC smoking.
Thing is, these researchers overlook that aortic stiffness has nothing to do with heart disease, nor does smoking cause it directly, yet the public health lobbyists conveniently ignore this salient fact. But there’s more, all nicotine replacement therapies increase aortic stiffness to varying degrees, along with the total failure to note that this reaction actually has a physiological purpose – to increase the rate of oxygenation at the end organs.
The overall conclusion we can take from this “letter” (and its impending study) is that the alarming assertion – as presented by the media – isn’t remotely supported by the data, or by anything else. If nicotine is the cause of the measured changes, there’s no reason for concern given what is already known about combustible tobacco.
But then, it’s not about health is it?