Experts say vaping may help you stop smoking, but there may be a trade-off with your health.

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Researchers say most people who switch to vaping to stop smoking regular cigarettes keep using e-cigarettes in the long term.
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People who use electronic cigarettes have a higher risk of stroke at a younger age than people who smoke traditional tobacco cigarettes.

That’s the conclusion of researchers in a study released today.

The findings are scheduled to be presented at the American Heart Association’s Scientific Sessions 2021 this weekend. The research hasn’t been peer-reviewed or published yet.

In their study, researchers looked at nearly 80,000 people with a history of stroke. Nearly 10 percent of the study participants used e-cigarettes. Another 60 percent used traditional cigarettes, while nearly 40 percent used both.

Researchers said that strokes occurred more often among traditional cigarette smokers, with 6 percent of them having strokes compared to 1 percent of e-cigarettes users and 3 percent of people who used both.

However, the researchers reported that e-cigarette users had a 15 percent higher risk of stroke at a younger age. This was despite the high risk of stroke among tobacco cigarette users.

The researchers said e-cigarette users had their first stroke at a median average age of 48 years old, compared to 59 years old for people who smoked cigarettes and 50 years old for people who used both.

“The public needs to know that e-cigarettes have not been proved to be safe and should not be considered as an alternative to traditional smoking especially among people with existing risk factors such as history of heart attack, high blood pressure, and high cholesterol,” wrote Dr. Urvish Patel, MPH, the study’s co-lead author as well as a research scholar and chief education officer in the department of public health and neurology at the Icahn School of Medicine at Mount Sinai in New York City.

Thomas Ylioja, PhD was fielding a lot of phone calls in early months of 2019.

As a tobacco expert and the associate clinical director of health initiatives at National Jewish Health, Ylioja had been giving his thoughts on a slew of research regarding e-cigarettes.

At the time, the electronic devices were already being blamed for reversing positive trends in lowering teenage smoking rates as kids who vape were more likely to try cigarettes.

Now, the “safer” claims marketed with e-cigarettes were being debated through various studies. While some experts pointed to e-cigarettes as a way to help people stay off traditional cigarettes, others pointed to potential increases in diseases associated with them, such as stroke and other cardiovascular ailments.

One study published in the The New England Journal of Medicine examined where e-cigarettes fit in with smoking cessation. Ylioja called the research a “well done” paper with its randomized design of 886 participants.

The study concluded that after 1 year of choosing a therapy, 18 percent of people who used e-cigarettes were still smoke-free, compared to the almost 10 percent who used noninhalable nicotine delivery methods such as patches, gums, or lozenges.

But there’s one thing about the study that stood out to Ylioja: 80 percent of e-cigarette users were still using the devices a year after the study began, compared to the 9 percent still using the other methods.

And people who use e-cigarettes were more likely to use the products while still smoking typically where vaping is allowed and smoking isn’t, he said.

As Healthline has reported, more states, counties, and cities are lumping e-cigarettes in with the traditional ones and banning them both indoors and in some outdoor public places.

Ylioja argued that because e-cigarettes are more discreet, they were reversing progress made on eliminating places were smokers can smoke. The fewer opportunities there are for someone to inhale nicotine, the reasoning goes, the more likely they are to quit nicotine altogether.

“You’re not raising the bar very high if it’s safer than smoking tobacco,” Ylioja told Healthline in February 2019.

He noted, in particular, the “volume of toxic chemicals” emitted from burning tobacco.

“It’s only better if it helps someone completely avoid combustible tobacco,” Ylioja said.

The American Heart Association released the findings of a study at its International Stroke Conference 2019.

Calling it “the largest study to date examining e-cigarettes and stroke,” researchers used responses from about 400,000 people in the 2016 behavioral risk factor surveillance system survey. Nearly 67,000 people reported using e-cigarettes at some point, while the rest hadn’t.

“Compared with nonusers, e-cigarette users were younger, had a lower body mass index, and a lower rate of diabetes,” Dr. Paul M. Ndunda, the study’s author and an assistant professor in the School of Medicine at the University of Kansas, said in a statement.

In other words, they had attributes that made them less likely to have cardiovascular-related problems, yet e-cigarette users still had higher risks of diseases often associated with smoking.

One was a 71 percent higher risk of stroke, as 4 percent of e-cigarette users reported having one. Other key findings include a nearly 60 percent increased likelihood of having a heart attack and 40 percent increase in risk of developing coronary heart disease.

The study also found that e-cigarette users had double the rate of smoking traditional combustible cigarettes.

However, the research was presented at a conference and had yet to appear in a peer-reviewed journal. This had some experts questioning its findings.

Patricia Folan, director of the Center for Tobacco Control at Northwell Health, says while studies like these can be useful because they could identify associations that can then be studied “using a more rigorous scientific method.”

“The problem with these types of studies is the difficulty in determining cause and effect rather than a simple association,” Folan told Healthline in 2019. “I’m not sure from reading this study if the e-cigarette users were also current or former smokers, which would’ve put them in a high category for stroke, heart attack, and diseased arteries whether or not they’d used e-cigarettes.”

Mark Ortiz, founder of the e-cigarette fluid company Belivio, also took issue with the study for not separating out e-cigarette users who didn’t smoke, saying “the study isn’t completely genuine.”

“It’s fair to say that tar buildup from cigarette smoking is only further worsened by the use of e-cigs due to the inflammation properties of e-cig use,” he told Healthline in 2019. “I really do believe that the study needs to run this research on individuals that only use e-cigs to properly assess the health issues.”

Because e-cigarettes have only been on the market since 2004, the long-term effects of their use are still unknown. Claims that they are safer come from the manufacturers of those products, Folan said.

“But we don’t have the scientific data yet indicating that they’re safe and effective — or even safer — for smoking cessation,” Folan said. “Many of them contain several cancer-causing chemicals, flavorings, and high levels of nicotine.”

In December 2018, Surgeon General Jerome Adams issued an advisory of the “epidemic of youth e-cigarette use.” He cited federal data that showed that last year 75 percent of high school-aged children reported using an e-cigarette in the past 30 days.

“We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in a statement.

Overall, Ylioja said the National Jewish Health’s guideline is to not recommend e-cigarettes for people who are trying to quit smoking.

That’s because they’re not approved for smoking cessation by the Food and Drug Administration (FDA), which currently regulates e-cigarettes as another tobacco product.

“It doesn’t help them quit nicotine,” Ylioja said of e-cigarettes.

The organization instead recommends the “gold standard” in helping people quit smoking: nicotine replacement therapies such as gums, patches, and lozenges, along with behavioral counseling.

Folan says Northwell Health uses that same type of standard of care, coupling FDA-approved smoking cessation medications with supportive coaching and various forms of counseling, which can double and triple success rates for quitting.

“If a person wants to use e-cigarettes, we’ll still work with them to reach their goal of quitting,” Folan said. “Some people have used e-cigarettes but find themselves smoking traditional cigarettes and e-cigarettes. They usually ask for help to quit both.”