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Graphical health warnings on cigarette packs found effective

A recently completed sample based study done in Bangladesh claims that the health warning labels describing the harmful effects of tobacco products using text and/or pictures are found to be effective.

Health warnings on cigarette packages are among the most prominent sources of information about the harms of smoking and tobacco use.

Indeed, even in high-income countries where millions of dollars are spent on anti-tobacco mass media campaigns, smokers still report getting information about the risks of smoking from cigarette packages almost as much as from television, and much more than from other sources such as print media.

Therefore, in a country such as Bangladesh, where very little information about the harms of tobacco use appears on television and other broadcast media, warning labels on tobacco packages represent an even more important opportunity for informing the public about the harms of tobacco. Given their tremendous reach and frequency of exposure, health warnings are an extremely cost-effective public health intervention compared to other tobacco prevention efforts such as paid mass media advertising – these came out of a sample-based survey.

Findings from the survey revealed, 98.1% of the respondents opined that they supported the current practice of bothside for pictorial/graphical health warnings (GHW) and 77.5% respondent informed that they thought that the current use of GHW of 50% of the cigarette pack for warnings was good enough to demotivate and reduce the use of tobacco products. Considering up to 50% of the cigarette pack, around 89% were supporting this.

The findings revealed – about 72.7% of the respondents reported that they felt very unpleasant to see the pictorial warning on the tobacco packets (74.1% in urban and 72.7% in rural areas). The survey also reported that the pictorial warning was very realistic to 65.6% of the respondents and extremely realistic to 17.0% respondent (18.8% in rural and 15.3% in urban areas).

The psychological impact of GHW on the respondents was also examined. 13.9% of the respondents were extremely worried and 61.7% were very worried to see the pictorial warning on the cigarette package.

In summary, the study found that the graphical health warnings (GHW) were realistic to provide health-related information and are very effective in creating an unpleasant feeling and sense of worriedness among the smokers to aware them regarding the harmful effects of smoking.

A good news that the study uncovered was 75.8% respondents tried to reduce or quit smoking after seeing the pictorial warning on the cigarette packet. The rate is 76.3% in rural and 75.3% in urban areas. 83.5% respondents reported that they tried to reduce or quit smoking habit to see the pictorial warning. 74.8% recommended to include
GHW in Biri, Gul and Jorda.

Moreover, 64.2% respondents recommended that government should take initiative for mass awareness and 85.5% recommended for more visual media (TV) coverage.

FCTC cut smoking 2.5 per cent over 10 years; study

A decade of tobacco control efforts by the Framework Convention on Tobacco Control (FCTC) has reduced the global smoking rate by 2.5 per cent, according to an evaluation by the International Tobacco Control Policy Evaluation Project.

http://www.tobaccojournal.com/FCTC_cut_smoking_2_5_per_cent_over_10_years_study.54157.0.html

Although the international treaty, an adjunct of the World Health Organisation, has made substantial progress in combatting use of tobacco products, implementation of FCTC measures has fallen short of its objectives, according to the study. “While the progress of WHO Framework Convention on Tobacco Control has been remarkable, there are still far too many countries where domestication of the treaty and its implementation has fallen short,” said Dr Geoffrey Fong, a study author from the University of Waterloo, Canada. “One important cause of this is the tobacco industry’s influence, particularly in low- and middle-income countries.”

Conducted with assistance from WHO, the study analysed data from 126 countries and determined the smoking rate in those countries declined on average from 24.7 per cent in 2005 to 22 per cent in 2015. FCTC obligates 180 signatory countries to raise tax on tobacco products, create smoke-free public spaces, implement warning labels on packaging, ban advertising and support stop-smoking services.

Study explores alarming threat of emerging Asian tobacco companies to global health

There are already one billion tobacco smokers worldwide, and this number is likely to rise further with Asian tobacco companies poised to enter the global market, according to SFU health sciences professor Kelley Lee.

http://www.sfu.ca/sfunews/stories/2017/03/theloomingthreatofasiantobaccocompaniestoglobalhealth.html

“While companies like British American Tobacco and Philip Morris, traditionally known as ‘Big Tobacco’, have been rightfully targeted by tobacco control efforts to date, on the horizon are several companies based in Asia ‘going global’ with their business strategies,” says Lee, a Tier I Canada Research Chair in Global Health Governance.

“Their aim is to grow their share of the world market through increased marketing, new products and lower prices. This is likely to mean more smokers worldwide.”

Lee and her team are the first to study the global business strategies of Asian tobacco companies, recently published in a special issue of Global Public Health entitled, “The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.”

Their aim in analysing companies in Japan, South Korea, China, Taiwan and Thailand was to document how these companies are shifting from a domestic focus to become aspiring transnational companies.

“Several of these companies have already started to export their brands to rapidly growing markets in Asia, Europe, the Middle East and Africa,” says Lee.

“Their success will mean a further increase to the already six million deaths caused by tobacco use each year.”

These new research findings suggest that globalization of the tobacco industry may be entering a new phase.

Rather than supporting the expansion of these companies as sources of profit, Asian governments need to recognize that far greater economic, environmental and social costs are being caused by this deadly industry.

The authors conclude that collective action by all countries, focused on the World Health Organization’s Framework Convention on Tobacco Control, is needed more than ever.

Lee sat down with SFU News to go over the five case studies that were examined in the special issue, and answered three questions about the findings:

What are the key factors behind the global business strategies of the five Asian tobacco companies?

Trade liberalization and tobacco industry lobbying pressured Asian countries to open their markets to transnational tobacco companies (TTCs) from the late 1980s. British American Tobacco, Philip Morris, R.J. Reynolds and other companies introduced new brands, marketing methods and undermined tobacco control measures to gain a major share of the market in Asia.

The loss of domestic market share also prompted Asian tobacco companies, in turn, to look abroad to grow their own foreign markets. Their global business strategies have borrowed many of the practices used by existing transnational tobacco companies.

Which global business strategies have Asian companies pursued?

Government supported consolidation, restructuring and rationalizing of domestic operations. This included shutting down facilities deemed inefficient, merging smaller concerns into larger ones and upgrading production capacity.

The companies also increased manufacturing, specifically for export to foreign markets, and engaged in new product development to create brands that have global appeal.

Moreover, there has been product innovation, including specially designed filters, flavourings, super slim cigarettes and electronic cigarettes, as well as foreign direct investment in the form of joint ventures, overseas manufacturing and leaf growing operations.

How globalized are Asian tobacco companies to date?

Japan Tobacco International was the first Asian tobacco company to successfully globalize, beginning in the late 1990s, supported by the Japanese government as part owners. Today, Japan Tobacco International is the third largest transnational tobacco company in the world.

Korea Tobacco & Ginseng is well positioned to become the world’s next transnational tobacco company given its active and successful pursuit of foreign markets since privatisation in 2001. The company is achieving rapid growth in eastern Europe, the Middle East and South Asia countries.

The China National Tobacco Company is by far the world’s largest tobacco company but to date has been largely domestically focused. Consolidation has been followed by a strong commitment by the state owned monopoly to “go global” over the next decade through exports, overseas manufacturing and leaf production.

Taiwan Tobacco and Liquor Corporation and Thailand Tobacco Monopoly have both expressed ambitions to globalize, but remain domestically focused and are more likely to become regional players in the foreseeable future.

Vapors Of High-Powered E-Cigarettes May Cause Cancer

http://www.sciencetimes.com/articles/10054/20170309/vapors-of-high-powered-e-cigarettes-may-cause-cancer.htm

People might have to stop powering their e-cigarettes to the highest level as scientists have found out that its vapors can cause cancer. There are significant levels of cancer-causing benzene in the vapors of those e-cigarettes in the highest power, stated Portland State University scientists.

The result of the study was published on March 8 in the online journal “PLOS ONE”. The chemistry professor James F. Pankow led the research team, reported EurekAlert. The level of benzene they found from the high powered e-cigarettes was thousand times higher than in the surrounding air. It also depends greatly on the device itself. If it is not at its highest level, the benzene levels are not that high.

When the e-cigarette fluid additive chemicals benzoic acid or benzaldehyde is present it added so much to the benzene levels. However, of course, the level of this is nothing compared to the level of a conventional smoke from a cigarette. Benzene is one component of gasoline. It is very bad for people.

It has been linked to a number of illnesses that are very grave and can cause death. Diseases like leukemia and bone marrow failure are few of the examples of diseases a person can acquire with benzene. Benzene is usually found in the urban areas where industrial emissions are very rampant plus fuel tank leaks. This chemical has been deemed as the largest single cancer-risk air component in the U.S.

Meanwhile, according to Science Daily, the smoke that conventional cigarettes release is affecting the natural healing process of lungs. The blocking then leads to chronic obstructive pulmonary disease or COPD. Cough, bronchitis and breathing difficulties are the major signs of COPD. The findings were published in “American Journal of Respiratory and Critical Care Medicine”. It was from the researchers at the Helmholtz Zentrum München, a partner in the German Center for Lung Research (DZL), and their international colleagues.

An individual with COPD does not heal its own lungs anymore. Researchers are now trying to find out why.

Vaping Is Less Terrible For You Than Cigarettes (Still Not Great For You, So Don’t Start)

Over time, people who smoke e-cigarettes seem to pile up fewer toxins in their bodies than people who smoke traditional cancer sticks.

https://www.fastcoexist.com/3068010/vaping-is-less-terrible-for-you-than-cigarettes-still-not-great-for-you-so-dont-start

Vaping devotees, you have been vindicated: In the first long-term study comparing e-cigarettes with regular old cigarettes, researchers found that e-cigs aren’t quite as bad for you as the tobacco they replace. In fact, transitioning to vaping may end up being a good way to help people quit smoking altogether.

The study, funded by Cancer Research U.K., found that people who switched from tobacco to e-cigarettes for at least six months “had much lower levels of toxic and cancer-causing substances in their body than people who continued to use conventional cigarettes.” The conclusion: e-cigarettes are less toxic than tobacco.

The study followed 181 participants over a six-month period. The participants were split into five groups: “combustible” cigarettes users, e-cigarette users, users of nicotine replacement therapy (NRT) like patches or gum, and people who smoke combustible cigarettes while also using either e-cigarettes or other NRT products.

Most studies up until now, as noted in the report, have examined the toxins in the actual vapor of the e-cigarette and compared that to the toxins in tobacco. But because the actual absorption levels of substances from e-cigarettes are not known, this may not be an accurate way to determine actual toxicity. Also, different vaping devices may deliver differing amounts of chemicals to the body.

This study instead examined the levels of toxins and carcinogens in the body over time, and found that they are lower in users of e-cigs than in regular smokers, and comparable to those found in people using other NRTs.

This is a big deal. While taking up vaping from scratch is still a bad idea, regular smokers who switch to e-cigarettes could do themselves considerably less harm than if they keep smoking tobacco. Ideally, e-cigarettes would be, like nicotine patches, used as an aid to eventually wean yourself off nicotine altogether, but even if you switch permanently to vaping, you’ll be healthier.

Vaping is still a young phenomenon—e-cigarettes were only patented in 2003—and the research is still scant. Even this study only looks at 181 individuals, and is funded by an organization that has a vested interest in reducing cancer. But really, it seems that pretty much anything is better for you than smoking. Apart from sitting down, that is.

E-cigarettes may pose the same or higher risk of stroke severity as tobacco smoke

Electronic cigarette (e-cigarettes) vaping may pose just as much or even higher risk as smoking tobacco for worsening a stroke, according to a preliminary study in mice presented at the American Heart Association’s International Stroke Conference 2017.

https://eurekalert.org/pub_releases/2017-02/aha-emp021517.php

Researchers found:

Mice exposed to e-cigarette vapor for 10 days or 30 days had worse stroke outcome and neurological deficits, than those exposed to tobacco smoke.

E-cigarette exposure decreased glucose uptake in the brain. Glucose fuels brain activity.

Both e-Cig and tobacco smoke exposure for 30 days decreased Thrombomodulin (anti-coagulant) levels.

From a brain health perspective, researchers said, electronic-cigarette vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity.

Use of e-cigarettes is a growing health concern in both smoking and nonsmoking populations. Researchers said rigorous studies are needed to investigate the effects of the nicotine exposure via e-cigarettes on brain and stroke outcome.

Ali Ehsan Sifat, Graduate Student/Research Assistant, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, Texas.

E-cigarettes users have lower carcinogen and toxin levels than smokers, study finds

Although this is a relatively small study, as the authors acknowledge, it indeed helps to elucidate some clarity on some central issues. One such issue is that that the study contributes to confirming that the continued use of both e-cigarettes and tobacco cigarettes, i.e. “dual use”, does not appear to significantly reduce the harms of smoking. Arguably, this is not “news”. One very large longitudinal study (1), followed 24 959 men and 26 251 women, aged 20–49 years, screened for risk factors of cardiovascular disease in the mid-1970s, screened again after 3–13 years, and followed up throughout 2003. The authors of this substantial longitudinal concluded that:

http://www.bmj.com/content/356/bmj.j651/rr

“Long-term follow-up provides no evidence that heavy smokers who cut down their daily cigarette consumption by >50% reduce their risk of premature death significantly. In health education and patient counselling, it may give people false expectations to advise that reduction in consumption is associated with reduction in harm.”

In retrospect, therefore, it have been somewhat misleading for an important evidence review like the 2014 Cochrane Review of E-Cigarettes (2) to make one of its primary outcome measures: a 50% reduction in tobacco consumption. Some observers are still, erroneously and misleadingly, publically claiming that “when people vape, they smoke less, even if they don’t manage to quit altogether. In other words, harm is reduced” (3). This claim, in fact, does smokers a significant dis-service.

Other reviews (4; 5) have highlighted, indeed, that even the so-called “light smoking” of only one to four cigarettes per day still risks producing significant harm, so, the results of this new study, in respect of dual use are, arguably, not that surprising. As the authors state, users of e-cigarettes must appreciate that, for there to be an appreciable benefit to their health, they need to fully switch away from tobacco cigarettes.

Unfortunately, it appears that, currently at least, the significant majority of e-cigarette users: firstly, either stop using them, finding that the devices fail to satisfy their cravings, are “not like smoking” a cigarette and are “messy fiddly devices” (6; 7); or, secondly, continue to dual use (8) along with tobacco cigarettes. Thus, the technology and chemistry involved needs to improve, if e-cigarettes are to fulfil the promise that some believe they have in truly competing with tobacco cigarettes.

The results here confirm, however, that a full switch to e-cigarettes, or nicotine replacement therapies, should significantly reduce exposure to the important cancer-causing toxins tested in this study – clearly, good news, in terms of cancer. However, the claim in the Cancer Research UK Press Release that “the long term effects of these products will be minimal” (9) is premature, and arguably, unscientific. The study could only test for a relatively limited number of the total of known relevant harmful substances: almost entirely related to cancer. It did not test for, for example, other important biomarkers, related to oxidative stress and the vascular system, that other studies using human subjects have (10), and which have indicated to expert toxicologists a “substantial exposure” and a concerning potential for harm, although, still less than from tobacco cigarettes (11).

Still other studies using human subjects, looking at different issues than this new study, have identified suppression of a significant number genes related to immunity and respiratory risks (12), and more recently, findings suggestive of inflammation and subsequent cardiac risk (13; 14).

This new study under review here, though helpful, is only part of the puzzle that is “e-cigarettes” – further, long term studies, following e-cigarette users for a prolonged period of time, tracking not just issues mostly related to cancer, but other specific respiratory and cardiac risks, are still required, before anyone can confidently claim that the harmful effects of switching purely to e-cigarettes are “minimal”. Further, as the authors indicate, it tells us nothing regarding the efficacy of e-cigarettes, which can currently only be described as either: very weak, at best (15): or detrimental to chances of cessation, at worst (16).

One of the observations regarding this new study is that, probably due to the predominant interests of the funder Cancer Research UK, its primary outcome measures were related to risks of cancer. Therefore, what the study did not consider are the potential cardiovascular effects of e-cigarettes, and the non-cancer respiratory effects. CDC data (17) demonstrates, importantly, that basically as many people die prematurely from the cardiovascular effects of smoking tobacco (160,000) as from cancer effects (163,700), so, if we then add on the premature deaths of the non-cancer lung disease (113,100), it becomes clear that the health effects of smoking are, unfortunately, very much more than those purely related to cancer.

‘‘All views are my own and do not necessarily reflect those of my employer”

1) http://tobaccocontrol.bmj.com/content/15/6/472.long
2) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010216.pub2/full
3) http://www.theglobeandmail.com/opinion/the-health-hazards-of-vaping-are-…
4) http://circ.ahajournals.org/content/121/13/1518
5) http://tobaccocontrol.bmj.com/content/14/5/315.full
6) http://substanceuseresearch.org/wp-content/uploads/2017/01/Pleasure.pdf
7) https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntw102
8) https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntw102
9) http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2017-…
10) http://journal.publications.chestnet.org/article.aspx?articleid=2518226
11) https://blogs.otago.ac.nz/pubhealthexpert/2016/07/04/what-does-recent-bi…
12) http://ajplung.physiology.org/content/311/1/L135
13) http://jamanetwork.com/journals/jamacardiology/article-abstract/2600166
14) http://www.atherosclerosis-journal.com/article/S0021-9150(16)31378-8/pdf
15) http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-…
16) http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00521-4/abstract
17https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/t…(15)00521-4/abstractco_related_mortality/index.htm

Competing interests: No competing interests

Study: Toxic Metals Found in ECigarette Liquids

FIVE METALS, TOXIC AND POTENTIALLY CARCINOGENIC WHEN INHALED, FOUND IN LIQUID OF LEADING FIRST GENERATION E-CIGARETTE BRANDS

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health found high levels of toxic metals in the liquid that creates the aerosol that e-cigarette users inhale when they vape.

The study, believed to be the first to examine a cross-section of metals in multiple e-cigarette brands, analyzed the liquid in five brands of first generation e-cigarettes for cadmium, chromium, lead, manganese and nickel.

The liquid is the component of e-cigarettes that, when heated, delivers ingredients, often including nicotine and flavors, to the user. In first generation e-cigarettes, the liquid is stored in the cartridge in close contact with the heating coil. The researchers found all five heavy metals – which can be toxic or carcinogenic when inhaled – in all five brands, though levels varied by brand. The main source of the metals, the researchers believe, is the coil that heats the liquid that creates the aerosol, which is often but erroneously referred to as vapor. The study did not look at the possible presence of metals in e-cigarette aerosol.

The findings appear in the January issue of the journal Environmental Research.

“We do not know if these levels are dangerous, but their presence is troubling and could mean that the metals end up in the aerosol that e-cigarette users inhale,” says study leader Ana María Rule, PhD, MHS, an assistant scientist in the Bloomberg School’s Department of Environmental Health and Engineering. “One of the things that is troubling is that the metals in e-cigarette coils, which heat the liquid that creates the aerosol, are toxic when inhaled, so perhaps regulators might want to look into an alternative material for e-cigarette heating coils.”

The Food and Drug Administration began regulating e-cigarettes last year, but has not yet issued warnings. Ecigarettes may be less harmful than cigarettes for current smokers who switch completely to electronic cigarettes. A serious concern is the appeal of e-cigarettes to young people who have never smoked, since ecigarettes might be habit forming, and might not be totally safe as emerging research shows that nicotine can adversely affect the developing adolescent brain. Last fall, then-U.S. Surgeon General Vivek Murthy called ecigarette use by young people a serious concern. E-cigarette use among high school students jumped 900 percent between 2011 and 2015.

For their study, the researchers selected five leading brands of so-called first generation e-cigarettes, which are referred to as cig-a-likes because they resemble traditional cigarettes. (Newer ones look like small cassette recorders with a mouthpiece. In the newer devices the liquid is added from a dispenser prior to use. In contrast, the liquid in first generation e-cigs is stored in the cartridge together with the coil, which increases the liquid’s exposure to the coil even in the absence of heating.) The five brands are sold across the United States in bigbox retail stores, convenience stores and gas stations, as well as online. Three of the five brands constituted 71 percent of total market share in 2015. If a brand came in more than one flavor, the researchers chose one flavor for consistency’s sake.

To test the liquid for metal levels, the researchers extracted samples of the liquid; the liquid had not been heated by the coil prior to extraction. The liquid is a mixture of propylene glycol, glycerin, nicotine and flavorings. Because liquid volume varied considerably from brand to brand, the research team tested for concentrations of metals in micrograms per liter.

The five metals – cadmium, chromium, lead, manganese and nickel – were present in all five brands, with cadmium markedly lower than the other metals and with a considerable range of concentrations among the brands. For instance, one brand had a high concentration of all five metals. In that brand, the concentration of nickel, which is considered the most serious carcinogen when inhaled, was 22,600 micrograms per liter, 400 times that of the brand with the lowest concentration of nickel. In that same brand, the one with the highest concentration of all five metals, the concentration of manganese was 690 micrograms per liter, or 240 times that of the lowest concentration in yet another brand.

“It was striking, the varying degrees to which the metals were present in the liquid,” Rule says. “This suggests that the FDA should consider regulating the quality control of e-cigarette devices along with the ingredients found in e-cigarette liquids.”

For now, FDA regulations require e-cigarette makers to submit ingredient lists as well as information about potentially harmful ingredients, including four of the five metals analyzed in this study – nickel, lead, chromium and cadmium. The FDA has yet to issue proposed regulations on e-cigarette labeling. In addition to the coil, the researchers believe some of the metals may come from the components of the e-cigarette device or the manufacturing process.

“E-cigarettes as a source of toxic and potentially carcinogenic metals” was written by Catherine Ann Hess, Pablo Olmedo, Ana Navas-Acien, Walter Goessler, Joanna E. Cohen and Ana María Rule.

This study was funded by the Institute for Global Tobacco Control, Johns Hopkins School of Public Health; National Institute of Environmental Health Sciences Training Grant T32ES007141-31A1; National Institute on Alcohol Abuse and Alcoholism Training Grant T32-AA014125 and the Alfonso Martín Escudero Foundation.

One Way e-Cigarettes May Up CV Risk: Altering HR Variability

http://www.medscape.com/viewarticle/875253

Habitual e-cigarette use may increase the risk of cardiovascular disease by shifting the cardiac autonomic balance toward greater sympathetic activity and increasing oxidative stress, according to new research[1].

“The central message for cardiologists from our study is that habitual e-cigarette use is associated with altered heart-rate variability in the same pattern seen in tobacco cigarette smokers,” Dr Holly R Middlekauff (David Geffen School of Medicine, University of California, Los Angeles) told heartwire from Medscape.

“This pattern of heart-rate variability has been associated with increased risk of myocardial infarction and sudden death in patients with heart disease, as well as in populations without known heart disease. Furthermore, habitual e-cigarette use is associated with increased susceptibility to oxidative stress, a critical component in the development of atherosclerosis,” she said.

Middlekauff and colleagues conducted a study involving 23 self-identified otherwise-healthy e-cigarette smokers and 19 otherwise-healthy nonusers between 21 and 45 years old in 2015 and 2016.

Using electrocardiography and blood tests, they analyzed heart-rate variability by high-frequency component, which signals vagal activity, low-frequency component, which mixes vagal and sympathetic activity, and the ratio of low frequency to high frequency, which reflects the cardiac sympathovagal balance.

The researchers found the high-frequency component to be significantly decreased in e-cigarette users compared with nonusers (standard error of the mean [SEM], 46.5 nu vs 57.8 nu; P=0.04). They found the low frequency and the low–to–high-frequency ratio to be significantly increased (mean [SEM] 52.7 nu vs 39.9 nu; P=0.03; mean [SEM] 1.37 vs 0.85; P=0.05) in e-cigarette users, which they write as being consistent with sympathetic predominance.

They found plasma cotinine levels to be significantly related with each heart-rate variability components, inversely to high frequency (P =0.04) and directly to low frequency (P=0.03) and low–to–high-frequency ratio (P=0.03).

They also found LDL oxidizability to be significantly increased in 12 e-cigarette users compared with 18 nonusers (mean [SEM] 3801.0 U vs 2413.3 U; P=0.01). Paraoxonase-1 tended to be lower in e-cigarette users, which they write as being consistent with less protection against oxidative stress.

The researchers pointed out that both increased cardiac sympathetic activity and increased oxidative stress are known mechanisms of how tobacco smoking increases the risk of cardiovascular disease.

“We can conclude that habitual e-cigarette use is associated with physiologic effects. Nonetheless, we cannot confirm causality on the basis of this single, small study; further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted,” the researchers write in an article published online February 1, 2017 in JAMA Cardiology.

Middlekauff said cardiologists should be telling their patients, “E-cigarettes have real, physiologic, adverse effects. If you don’t already smoke tobacco cigarettes, don’t start using e-cigarettes. They are not harmless.”

As for further research, she added, “We need to know whether the cardiac risks associated with e-cigarettes are as great as those associated with lethal tobacco cigarettes. We need to know which component of the e-cigarette aerosol is driving these adverse physiologic effects.”

In an accompanying editorial[2], Dr Aruni Bhatnagar (University of Louisville, KY) writes that the nicotine in e-cigarettes “is a strong vasoactive drug that can profoundly affect cardiovascular function and health. . . . It has been shown that smoking e-cigarettes increases heart rate as well as diastolic and systolic blood pressure to levels comparable with those observed with conventional cigarettes.”

He praised the researchers involved in the new study: “Such investigations are critical for evaluating how harmful e-cigarettes are and whether their widespread acceptance will decrease the incidence of cardiovascular disease or, by renormalizing smoking and promoting nicotine addiction, erode public-health gains made by evidence-based tobacco control and regulation.”

Outside supporters of this research included the American Heart Association, the National Institute of Environmental and Health Sciences, and the Irma and Norman Switzer Dean’s Leadership in Health and Science Scholarship program. The authors and editorialist reported no relevant financial relationships.

Study adds to evidence that electronic cigarettes are not harmless

http://www.alphagalileo.org/ViewItem.aspx?ItemId=172149&CultureCode=en

A study published in JAMA Cardiology has added to growing evidence that electronic cigarettes (e-cigarettes) are not harmless.1

“Studies like this give further confirmation that e-cigarettes are not harmless,” said European Society of Cardiology cardiovascular prevention spokesperson Professor Joep Perk.

“If I was a minister of health I would put my efforts into public anti-smoking campaigns especially directed towards the younger generation, and not promote e-cigarettes as an alternative to smoking,” he continued. “There are studies also showing that people that start with e-cigarettes have a tendency to become persistent tobacco cigarette smokers as well.”

The 2016 European guidelines on cardiovascular disease prevention flagged up the need for further research on the long-term effects of e-cigarettes.2

The current study included 23 habitual e-cigarette users (used most days for at least one year) and 19 non-users between the ages of 21 and 45 years. It found that habitual e-cigarette users were more likely than non-users to have increased cardiac sympathetic activity (increased adrenaline levels in the heart) and increased oxidative stress – known mechanisms by which tobacco cigarettes increase cardiovascular risk.

The authors said the findings “have critical implications for the long-term cardiac risks associated with habitual e-cigarette use” and “mandate a re-examination of aerosolized nicotine and its metabolites”. They added that causality could not be confirmed on the basis of this single, small study, and that further research into the potential adverse cardiovascular health effects of e-cigarettes is warranted.

“Nicotine stimulates the central nervous system, so it’s not at all surprising that people continuously taking nicotine get this sympathetic stimulation,” said Professor Perk. “This then might lead to irregular heartbeat and raised blood pressure, and probably has long-term deleterious effects on the blood vessel walls.”

“It is too large a step to say that these negative effects are proof that people are going to die early because they used e-cigarettes,” he continued. “To prove this you have to put people on e-cigarettes for 10 to 15 years and see how many die early – a study that will not be done for ethical reasons. The weakness of all studies in this field is that they are observational and small, and they look at indicators of vascular wall damage rather than incidence of cardiovascular disease or death.”

Professor Perk said that, even after this study, e-cigarettes could still be used to help people stop smoking tobacco cigarettes, but they should be used with caution and other methods should preferably be tried first.

He said: “E-cigarettes are one of the tools we have in nicotine replacement therapy but as clinicians we should be cautious of putting people on large amounts of central nervous system stimulant drugs. Other smoking cessation schemes, such as chewing gum or patches, always include the decision to taper off use and eventually stop. This is not in general the case with e-cigarettes, which tend to be seen as a replacement and not a weaning off nicotine addiction. In fact they prolong the addiction.”

“This is an area where we need more knowledge,” continued Professor Perk. “The more data we collect, the more it seems that nicotine replacement strategies that taper off and ultimately end nicotine use are the way to go.”

“At the end of the day the best thing is simply to prevent people ever getting into the vicinity of nicotine,” he concluded.