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European group: E-cigarette use should be limited due to CV effects

In a new position paper, the European Association of Preventive Cardiology recommended that due to known CV harms from e-cigarettes, they should not be used for smoking cessation except as a last resort.

“E-cigarettes should only be used for smoking cessation if nothing else has worked and the individual is carefully monitored for adverse effects,” Maja-Lisa Løchen, MD, PhD, professor of preventive medicine at UiT The Arctic University of Norway, Tromsø, professorial fellow at Australian Catholic University and an author of the paper, said in a press release issued by the European Society of Cardiology, with which the EAPC is affiliated.

The authors noted that e-cigarette use has been rising, especially among youth, and that meta-analyses suggest such use is associated with elevated risk for CV events, driven by minor events such as arrhythmia and palpitations.

There is also evidence suggesting that nicotine, regardless of its source of delivery, is linked with impaired vascular function and vascular calcification, Løchen and colleagues wrote.

The impact of e-cigarettes on smoking cessation “has not been comprehensively addressed to date,” the authors wrote, noting that there is not conclusive evidence that e-cigarettes work better than nicotine patches or other methods.

Therefore, Løchen and colleagues wrote, these steps should be taken:

  • Health care providers should be cautious in recommending e-cigarettes for smoking cessation;
  • Providers should only recommend e-cigarettes if used in conjunction with a formal tobacco cessation program;
  • Policymakers should ban e-cigarettes or strongly regulate their use;
  • Legislation related to e-cigarettes should be updated regularly;
  • E-cigarette marketing, especially to youth, should be regulated the same way as tobacco cigarette marketing;
  • Pregnant women should not use e-cigarettes;
  • Information about negative effects of e-cigarettes should be included in lifestyle programs at schools;
  • More studies on the CV effects of e-cigarettes should be funded; and
  • Countries should follow the WHO Framework Convention on Tobacco Control.

“Action is urgently needed to halt the growing use [of e-cigarettes] in young people,” Løchen said in the release. “The WHO states that e-cigarettes are harmful to health. E-cigarettes are a relatively new product and the long-term health effects are unknown. Now is the time for politicians and regulators to act — with public health campaigns to increase awareness and legislation to halt uptake in young people.”

In a related editorial, Joep Perk, MD, PhD, FESC, professor of health and life sciences at Linnaeus University, Kalmar, Sweden, wrote that “the outcome of using electronic nicotine delivery systems as a smoking cessation method has not been promising; only in combination with behavioral support at a dedicated clinic did the method prove to be superior to conventional therapy. However, a majority of the participants continued with e-cigarettes long term. Furthermore, e-cigarettes do not replace or limit tobacco smoking as half of its users will transfer later in life to conventional smoking.”