Vascular stiffness after vaping
One who early investigated the health effects of the new tobacco products is Magnus Lundbäck, associate professor of cardiology at the Department of Clinical Sciences, Danderyd Hospital. His research career began with studies on how blood vessels are affected by diesel exhaust. With the same methods, he has studied cigarettes, both conventional and vaping.
His first study on e-cigarettes, published in 2016, included 16 infrequent vapers who were asked to puff ten times on an e-cigarette over the course of ten minutes. Various controls were conducted over a 24-hour period. All values were compared with the study participants’ own over a 24-hour period when they had not vaped.
One hour after vaping, biomarkers in the blood indicative of vascular damage were found. After 24 hours, however, the levels had returned to normal.
In recent studies, his research team have been able to show more acute effects from e-cigarettes. Shortly after vaping, airways are narrower, blood vessels are stiffer and blood-clotting properties increase.
Research on conventional cigarettes reveals a similar pattern: occasional use causes acute harm that eventually subsides. However, smoking conventional cigarettes over many years leads to chronic issues, including vascular stiffness, increasing the risk of heart attacks and strokes. The long-term effects of vaping remain unexplored, according to Magnus Lundbäck.
Interestingly, nicotine-free e-cigarettes do not produce the same vascular effects.
“The conclusion is that it is the nicotine itself that causes the damage,” says Magnus Lundbäck.
Conventional cigarette smoke contains thousands of substances, such as tar, arsenic and hydrogen cyanide. Separating nicotine’s specific effects from this toxic mix has been challenging. Despite knowing for decades that conventional cigarettes harm vascular health, distinguishing between smoke and nicotine’s impact has proven difficult. Tobacco companies have positioned smoke-free cigarettes, i.e. e-cigarettes, as less harmful, suggesting they are a viable alternative for those who want to quit conventional cigarettes.
Helpful aid or gateway to addiction
This question is central to the discussions about new tobacco products. Is vaping a helpful aid for quitting smoking conventional cigarettes, or does it serve as a gateway for young people who have not previously used tobacco products? Or perhaps is it both? If so, how should the benefits balance against risks?
The New England Journal of Medicine recently published a study involving nearly 1 250 smokers who wanted to quit. Participants were randomly assigned to two groups: one group received standard smoking cessation treatment plus free, optional nicotine replacement therapy, while the other received standard smoking cessation treatment plus free e-cigarettes.
All participants set a quit date. After six months, 29 percent of the vapers had successfully quit and remained smoke-free, confirmed by urine tests. In the control group, progress was slower. Only 16 percent quitting on their planned quit date.
Interestingly, vapers clung more tightly to their nicotine habit. At the same six-month follow-up, 20 percent of those who vaped had completely quit nicotine. In the control group, the corresponding figure was 34 percent. Additionally, vapers experienced more respiratory issues, such as coughing.
Does this mean that e-cigarettes are beneficial for quitting, or do they perpetuate nicotine dependence?
Magnus Lundbäck emphasises that the long-term effects of e-cigarette use remain unexplored.
“The industry would like nothing more than for people like me to say that e-cigarettes are less harmful than conventional cigarettes. But why compare them to something as incredibly harmful to health as cigarettes? If that were the case, we should be highlighting the fact that conventional cigarettes are less dangerous than crack, but we are not. The only reasonable thing is to compare e-cigarettes with regular clean air, to compare use with non-use,” he says.
Independent nicotine researchers face scrutiny from the tobacco industry,” says Magnus Lundbäck. Following the publication of the 2016 study, industry-sponsored researchers challenged the interpretation of e-cigarettes as harmful.
“I think that is entirely appropriate. Everyone has the right to comment on research. We addressed their objections in a response we sent to the journal. In one passage, we mentioned that our critics had conflicts of interest because they were sponsored by the e-cigarette industry,” says Magnus Lundbäck.
Shortly afterward, a subpoena arrived in the mailbox. The sender? Researchers with conflicts of interest to the industry. The journal received the same message. All this occurred during correspondence before publication. The result was that the journal backed down, and the section highlighting the conflicts of interest was removed. The rest was published.
“We have more examples of how closely we are monitored. For instance, representatives of the nicotine lobby were present and filmed an entire doctoral thesis defence a while back. Then they compiled a rather peculiar summary and published it through their own channel,” Magnus Lundbäck recalls.