Vaping and stroke risk: Balancing harm reduction & risks

Vaping has emerged as a crucial tool in public health efforts to reduce the devastating effects of smoking. By eliminating tar and carbon monoxide—two of tobacco’s most dangerous components—e-cigarettes offer smokers an alternative that may significantly lower their risk of developing lung cancer, heart disease, and other smoking-related illnesses [1].

This harm reduction approach has led many health authorities, including the NHS and British Heart Foundation, to acknowledge that vaping poses “a small fraction of the risks of smoking” [1]. However, vaping is not without risks, and emerging research suggests a more nuanced picture regarding cardiovascular outcomes, particularly stroke risk.

Recent Research Findings

A 2022 cross-sectional study published in the MDPI journal analyzed data from the National Health and Nutrition Examination Survey (NHANES) covering 2015-2018 [2]. This research examined the association between e-cigarette use and stroke prevalence across different population groups.

The study revealed several noteworthy findings:

• Stroke prevalence among exclusive e-cigarette users was 1.57%, significantly lower than the 6.75% observed in traditional cigarette smokers, but higher than non-users [2].
• Perhaps most concerning, e-cigarette users who experienced strokes were considerably younger (median age 48) compared to traditional smokers who had strokes (median age 59) [2].
• The research highlighted that over 60% of e-cigarette users also smoked traditional cigarettes, creating a complex risk profile that makes attribution difficult [2].

Important Study Limitations

While the MDPI study provides valuable insights, several limitations must be considered when interpreting its results:

1. The cross-sectional design cannot establish causality or determine whether e-cigarette use preceded stroke occurrence [2].
2. The study relied on self-reported data, which introduces potential for underreporting or misclassification of both e-cigarette use and smoking status [2].
3. Despite statistical adjustments, the research may not have fully accounted for all confounding factors such as socioeconomic status, dietary patterns, and relevant comorbidities like hypertension [2].
4. The relatively small number of strokes among e-cigarette users limited the statistical power for more detailed demographic analyses [2].
5. The study lacked device-specific data, failing to account for variations in e-cigarette hardware, nicotine concentrations, and potential aerosol toxicants [2].

Balancing Risk Reduction and Caution

The current UK health guidance emphasizes vaping’s potential for harm reduction compared to traditional smoking [1]. However, the MDPI study suggests that even exclusive e-cigarette use may correlate with stroke risk, particularly among younger populations [2]. The prevalence of dual use—simultaneously using both e-cigarettes and traditional cigarettes—further complicates individual risk assessment [3].

Conclusion

While current evidence supports e-cigarettes as a less harmful alternative to smoking, the MDPI study underscores the need for comprehensive longitudinal research to clarify specific cerebrovascular risks [2]. Public health strategies should continue prioritizing smoking cessation while cautioning against non-smoker uptake and dual use patterns.

For those using e-cigarettes as a smoking cessation tool, the research suggests maintaining the ultimate goal of nicotine cessation altogether may be the optimal approach for cardiovascular health [4].

References:

[1] NHS UK. “Using e-cigarettes to stop smoking.” https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/

[2] Parekh, T., et al. (2022). “Association Between E-Cigarette Use and Stroke: A Cross-sectional Study of NHANES, 2015–2018.” MDPI Journal. https://www.mdpi.com/2305-6304/10/2/95

[3] British Heart Foundation. “Is vaping harmful?” https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/e-cigarettes

[4] Public Health England. “Evidence review of e-cigarettes and heated tobacco products.” https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review