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Experts say the public needs to understand that e-cigarettes aren’t a healthy alternative to tobacco use. Getty Images
  • A new study concludes that e-cigarettes tend to decrease blood flow to the heart.
  • A second study states that e-cigarettes negatively affect heart-related issues, such as cholesterol and glucose levels, more than traditional tobacco cigarettes.
  • Researchers said they want to get out the message that e-cigarettes aren’t a safe alternative to traditional cigarettes.

As more evidence points to e-cigarettes damaging the lungs, two new studies are adding another concern about the popular vaping product.

When it comes to the heart, e-cigarettes may actually be more damaging to that vital organ than tobacco — a finding that surprised the researchers conducting the studies.

The research is being presented later this week at the American Heart Association’s Scientific Sessions 2019 in Philadelphia.

It hasn’t been published yet in a peer-reviewed journal.

In the two studies, researchers concluded that e-cigarettes negatively affect heart disease risk factors, such as cholesterol, triglycerides, and glucose levels, as well as decrease blood flow in the heart more than traditional cigarettes.

That may just be the tip of the iceberg, says Dr. Florian Rader, a lead study researcher and medical director of the human physiology laboratory as well as assistant director of the noninvasive laboratory at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles.

“The harms of e-cigarettes have been clearly shown now for the lung. Our results are part of emerging data showing potential harms to the heart,” Rader told Healthline. “There are likely other organs and organ systems that are affected in ways that we are not yet aware of.”

Rader and his team were motivated to do the research, he says, after seeing the surge in e-cigarette use.

“Having seen the incredibly fast uptake of e-cigarette use in our own local communities as well as across the country, we felt strongly compelled to find out how the effects of e-cigarettes compared to what we had seen for conventional cigarettes,” he said.

Radar and his team analyzed heart blood flow — a measure of coronary vascular function — of 19 young adult smokers between the ages of 24 and 32 immediately before and after smoking either e-cigarettes or traditional cigarettes.

They examined coronary vascular function via an imaging tool called myocardial contrast echocardiography while participants were at rest and after performing a handgrip exercise to simulate physiologic stress.

Hypothesizing that the e-cigarettes would have a lesser impact, the researchers were surprised to find just the opposite.

They reported that blood flow modestly increased after traditional cigarette inhalation and then decreased with subsequent stress.

“However, in smokers who use e-cigs, blood flow decreased after both inhalation at rest and after handgrip stress,” Rader said. “These results indicate that e-cig use is associated with persistent coronary vascular dysfunction at rest, even in the absence of physiologic stress.”

In other words, e-cigarettes may be worse for the heart than tobacco.

“Not quite knowing what to expect, we thought that e-cigarette use might turn out to be somewhat less deleterious than conventional cigarette use, or perhaps just as deleterious, in part because of what we knew about the variable and sometimes lower amounts of nicotine in e-cigarettes compared to conventional cigarettes,” Rader said. “And so, we were surprised by our results.”

A second study was led by Dr. Sana Majid, a resident physician in internal medicine at Beth Israel Deaconess Medical Center in Massachusetts.

The study looked at the impact of e-cigarettes compared with traditional tobacco on heart-related issues, such as glucose and cholesterol levels.

Like Rader, Majid and her team were curious to find out whether e-cigarettes had a less stressful impact.

Their findings, though, concluded that e-cigarettes negatively affect those heart-related issues in at least the same level as tobacco does, if not more.

This, Majid says, should be taken seriously by e-cigarette users who may think they’re making a healthy choice.

“Many people, especially kids and teenagers, have the belief that e-cigarettes are harmless. We want everyone to know that there are many chemicals in e-cigarettes that may alter heart health,” Majid told Healthline.

“Our study is an early view, suggesting that there may be a relation between e-cigarette use and an unhealthy cardio metabolic state,” she said.

Dr. Rose Marie Robertson, FAHA, deputy chief science and medical officer at the American Heart Association (AHA), told Healthline that she and her organization are hoping these findings will spur more research as well as open the minds of people who have long assumed that e-cigarettes are a safe choice.

“Investigators in the AHA’s Tobacco Center for Regulatory Science and others who are studying the perceptions and beliefs of both youth and adults are finding that many are misled by the messages delivered about e-cigarettes by industry, either directly or subliminally,” Robertson said.

“These include statements that these products are ‘totally safe’ and suggestions that they are highly effective in supporting quitting the use of combustible tobacco products,” she said.

Robertson adds that many people believe e-cigarettes have been vetted and approved by the Food and Drug Administration (FDA), which isn’t the case.

“Many in the public believe that commercially available e-cigarettes are regulated by the FDA, when the opposite is true,” Robertson said.

“These products are allowed to be sold prior to testing and approval by the FDA under a time-limited waiver that we believe has been extended for much too long, in effect allowing industry to experiment on the public, supported by enormous and misleading marketing budgets. An essential part of their approach has been the use of flavors that have enticed many youth to experiment and then become addicted,” she said.

Younger people, Robertson says, along with pregnant women are most at risk.

What happens from here?

Researchers hope to dig deeper, and the American Heart Association hopes to keep that data flowing directly to the public to change the perception that e-cigarettes are a healthy choice.

Rader and his team will continue their studies and look at the potential impact on the heart for people who already are at risk for heart issues.

“We feel this will be especially important to figure out because e-cigarettes are still thought of by many as a way for conventional tobacco cigarette smokers to try to quit,” he said.

Majid and her team will dig deeper as well.

“We are continuing to follow up with our study participants to see how glucose and cholesterol change over time with prolonged e-cig use. We are also studying the effects of newer pod-based electronic cigarette products like JUULs,” she said.

The American Heart Association, Robertson says, will continue to support such studies and work at helping the public not just understand — but accept — the findings.

“The ever-increasing numbers of people using e-cigarettes, especially among our youth, is a public health crisis and must be urgently addressed,” Robertson said. “The American Heart Association remains steadfast in our commitment to a tobacco-free world.”