Daily e-cig users face twice the risk of a heart attack as non-vapers, new study suggests

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• The true effects of e-cigarettes on human health are
  
  just beginning to emerge.
• Risks of vaping include inhaling toxic
  metals like lead and potentially doubling one’s risk
  of a heart attack, according to a new study published by UCSF
  researchers.
• Despite these emerging health concerns, e-cig companies
  like Juul, the Silicon Valley startup recently
  valued at $15 billion, are
  booming.

---

Smoking kills. No other habit has been so strongly tied to death.

In addition to inhaling burned tobacco and tar, smokers
breathe in toxic metals like cadmium and beryllium, as well
as metallic elements like nickel and chromium — all of which
accumulate naturally in the leaves of the tobacco plant.

It’s no surprise, then, that
much of the available evidence suggests that vaping, which
involves puffing on vaporized liquid nicotine instead of inhaling
burned tobacco, is at least somewhat
healthier. But vaping is linked with its own set of health
risks, a spate of new research is
beginning to reveal. Those risks include
inhaling toxic metals like lead,
becoming addicted to nicotine, and now, potentially doubling
one’s risk of a heart attack.

That latest finding comes from a large study out of the
University of California, San Francisco. The study suggests that
people who vape every day may face twice the risk of a heart
attack compared with people who neither vape nor smoke at all.
The research also suggests that daily conventional cigarette
smokers face three times the risk of a heart attack, while people
who both vape and smoke (so-called “dual users”) face nearly five
times the risk.

That should be a significant concern for e-cig users who also
smoke cigarettes, Stanton
Glantz, the lead author on the paper and the director of the
Center for Tobacco Control Research and Education at the
University of San Francisco, told Business Insider. It also adds
to a growing list of health concerns faced by e-cig companies
like Juul, the
booming Silicon Valley startup recently
valued at $15 billion.

‘We’re the first people to show a long term impact of
e-cigarettes’

Eduardo
Munoz/Reuters

Glantz’ recent paper, published on Wednesday in the American
Journal of Preventive Medicine, is one of the first studies of
its kind to show a long-term health impact of e-cigarettes.

Business Insider spoke with Glantz in February when the
peer-reviewed summary of his study was first made public. 

He and his research team
presented those findings early in an attempt to get the word
out about the research — which he found deeply concerning — as
soon as possible.

“We’re the first people to show a long term impact of
e-cigarettes, and given that it’s consistent with what we know
biologically about how vaping effects the heart, we wanted to get
this out there,” he said. 

Still, the study has a number of limitations, most notably the
fact that it could not conclude that vaping (or even smoking, for
that matter) caused heart attacks — only that the two were
linked.

To arrive at the findings, Glantz and his research team looked at
national survey data on 70,000 Americans which asked people about
their use of e-cigarettes and regular cigarettes. It also asked
if they’d ever suffered a heart attack. After controlling for
factors that could muddle their results, like hypertension, the
researchers found that people who vaped every day were twice as
likely to have suffered a heart attack as people who didn’t vape
or smoke at all. Daily smokers were three times as likely as
non-smokers to have suffered a heart attack.

The people most at risk, however, are “dual users,” or people who
both vape and smoke. Dual users faced approximately five
times the risk of a heart attack as those who took up neither
habit, the study suggested.

Other studies in animals and cells have suggested that vaping

could stiffen the heart and blood vessels, potentially
creating an increased risk of heart disease and heart attacks,
but this was the first to line up those limited findings with
actual health impacts in humans.

People who vape and smoke are most at risk

Spencer
Platt/Getty

Many e-cig manufacturers promote their devices as a tool for
either quitting smoking or for “switching” from smoking
conventional cigarettes to vaping, which is generally seen as
less harmful.
Juul, the San Francisco-based startup behind the most popular
e-cig in America,
encourages consumers to “make the switch” from traditional
cigarettes to the Juul.

But the new study suggests that the people most vulnerable to an
increase in heart attacks are those who make both smoking and
vaping a daily habit. Glantz said this group of people also
represent the largest population of e-cig users.

”E-cigarettes are widely promoted as a smoking cessation aid but
for some, they actually make it harder to quit, so most people
end up doing both,” Glantz said. “This is the dominant
use.”

Juul, which was
recently valued at $15 billion and is already
rapidly expanding both in the US and internationally, has

come under fire for a range of other health issues, namely
its popularity among teens who are particularly susceptible to
nicotine addiction. 

“At Juul Labs, our definition of switching is aligned with the
American Cancer Society, National Academy of Science, and Public
Health England: Smokers should switch completely away from
combustible tobacco,” a representative for the company told
Business Insider.

“We are committed to helping current adult smokers who want to
end their relationship with combustible cigarettes.”

Snowballing evidence of health concerns tied to vaping

California Department of Public
Health

Evidence still suggests that inhaling vapor is healthier than
breathing in burned tobacco. Still, researchers urge people to
recognize that e-cigs come with their own set of health concerns.

Chief among those issues is the high concentration of nicotine in
e-cig fluid. This may be part of the reason why teens who vape
are seven
times more likely to smoke regular
cigarettes than young people who never use e-cigs.

Ana Rule, a professor of environmental health and engineering
at Johns Hopkins University, said the makers of these devices
fail to address “the increased risk to this huge market they are
creating among teenagers and young adults that never have smoked,
and would have never even considered smoking” had they not vaped.

Researchers are also not convinced that e-cigs actually help
adult smokers quit.

So far, the evidence suggests they don’t. In January,
a study
in the journal The Lancet found that e-cigs
were linked with “significantly less quitting” among smokers.
Several months later, a study
in the Annals of Internal Medicine found
that e-cig users were less likely than non-vapers to abstain from
tobacco use over six months. And a
study published
in the journal PLOS One this month found no evidence that
vaping helped adult smokers quit.

Nicholas Chadi, a clinical pediatrics fellow at Boston
Children’s Hospital, spoke about the Juul at the American Society
of Addiction Medicine’s annual conference in April.

“After only a few months of using nicotine, [these teens] describe cravings, sometimes intense ones. Sometimes they also
lose their hopes of being able to quit,” Chadi said.

For these reasons, several nonprofit anti-tobacco agencies
strongly oppose Juul, including the nonprofit
Campaign for Tobacco-Free Kids and the
California Department of Public Health. On Tuesday, Israel became
the first country to
ban Juul devices entirely, citing health concerns
linked with the their high nicotine content. In a statement,
Israel’s Health Ministry said the devices pose “a grave risk
to public health.”