Every discussion of vaping should include a comparison with smoking. That’s because most vapers were smokers, and if not for vaping, most vapers would still be smokers. On top of that, if vaping survives the huge challenges to its very existence, millions of would-be smokers will be diverted from cigarette addiction by low-risk nicotine alternatives like e-cigarettes.
But when it comes to actual science, far too few studies employ a direct comparison between vaping and smoking. That’s probably because studies are done largely by people in the tobacco control field, and most of them want to see total elimination of all nicotine use.
So if a paper compares, say, carcinogenic compounds in smoke and vapor, the results will show that smoke contains vastly larger quantities of the things that cause cancer. And pointing that out doesn’t serve the cause of abstinence very well. However, comparing vapor to clean air makes vapor look bad.
Vaping vs smoking: health effects
More than sixty years of science has proven that smoking is a very risky activity. Around half of all long-term smokers will die prematurely from its effects. The science on vaping is much newer, but what we do know is that no serious or widespread harms have been proven.
According to the 2014 Surgeon General’s report on smoking, about 16 million Americans suffer from some smoking-related disease, with 480,000 of them dying each year. Let’s look at the major categories of health problems caused by smoking and see if vaping poses risks in the same areas.
Cancers form when toxins damage or mutate a cell’s DNA and cause it to grow out of control. A tumor can remain local, or the cancer can spread, and even move from one organ to another.
Most people are familiar with cigarette smoking as a cause of lung cancer. Lung cancer kills more Americans than any kind of cancer, and most (but not all) lung cancer victims are smokers. It is a particularly brutal form of cancer.
However, smoking can cause many other kinds of cancer too, because cancers can form not just in areas that have contact with the smoke, but also from smoke byproducts in the bloodstream and organs. According to the Centers for Disease Control and Prevention (CDC), smoking can cause cancer almost anywhere in the body.
Some of the cancers that can be caused by smoking are:
- Blood (leukemia)
- Colon and rectum
- Esophagus and trachea
- Kidney and renal pelvis
- Mouth and throat
Nicotine itself — either in cigarettes or e-cigs, or other nicotine products — has not been shown to cause cancer. Long-term studies of nicotine replacement therapy (NRT) and Swedish snus users show no provable link between nicotine and cancer.
The 2016 Royal College of Physicians (RCP) report “Nicotine Without Smoke” says that “robust evidence on the safety of long-term nicotine use in humans from the 5-year Lung Health Study, in which participants were actively encouraged to use NRT for several months and many continued to consume NRT for a much longer period, demonstrates no association between sustained NRT use and the occurrence of cancer (lung, gastrointestinal or any cancer) or cardiovascular disease.”
Cancers from smoking are caused by the combustion of tobacco. The smoke forms a sticky chemical slurry called tar, and the tar coats delicate parts of the lungs. Over the course of years, the damage created by tar in the lungs can lead to tumor growth. According to the National Cancer Institute (NCI), most of the cancer-causing substances in cigarette smoke are in the tar. Tar also causes damage that can lead to lung diseases like emphysema and bronchitis.
E-cigarettes don’t produce tar, because they don’t burn (or even contain) tobacco or other plant material. There are known carcinogens in vapor, but they’re in tiny concentrations that are unlikely to pose any risk to vapers. Most studies that have raised alarms about cancer risk from vaping have used poor methods, including using smoking machines to take too-frequent or too-long drags, or vaping at unrealistic high temperatures on dry wicks. Those things wouldn’t happen to actual vapers, because the result — known as dry hits or dry puffs — is unbearable to breathe.
“In normal conditions of use, toxin levels in inhaled e-cigarette vapour are probably well below prescribed threshold limit values for occupational exposure, in which case significant long-term harm is unlikely,” says the RCP report. “Some harm from sustained exposure to low levels of toxins over many years may yet emerge, but the magnitude of these risks relative to those of sustained tobacco smoking is likely to be small.”
A recent study at the University of St. Andrews in Scotland found that the cancer danger of vaping is almost as low as for nicotine replacement therapies like patches and gum — less than one percent. “This study should put to rest any doubt within the tobacco control movement about whether vaping greatly reduces health risk compared to smoking,” wrote Boston University’s Dr. Michael Siegel.
Heart disease and stroke
Smoking cigarettes causes about a third of all the heart disease deaths in the United States every year, according to the Surgeon General. Those deaths come in the form of heart attacks, heart failure, stroke, aneurisms, sudden cardiac arrest, and several other kinds of cardiovascular events that can be caused by conditions in the body that are caused or made worse by smoking.
As with cancer, nicotine isn’t a primary cause of acute cardiovascular events. The Surgeon General’s 2014 report says that “international epidemiologic evidence, and data from clinical trials of nicotine patches, suggests that chemical components in smoke other than nicotine are more important in elevating the risk of death from MI [myocardial infarction — heart attacks] and stroke.”
However, if you’re already suffering from heart disease, it may be prudent to reduce your nicotine intake. Nicotine can cause short-term spikes in heart rate and blood pressure, and people with existing risk factors for acute coronary events may have some added danger from using nicotine.
By and large, it’s the other things in smoke that cause heart disease and death. Oxidant chemicals, free radicals, particulates, and carbon monoxide all damage the heart and circulatory system in many ways, according to the CDC.
Smoking can raise triglycerides and lower the HDL (“good”) cholesterol, and increase the buildup of plaque (from fat, cholesterol, calcium and other substances) in blood vessels. It can also thicken and constrict the vessels, and damage the cells that line them. It reduces oxygen in the blood and makes it sticky and more prone to clot. And when blood clots, it can block the flow to the heart and brain, causing heart attacks and stroke.
Some of the dangerous compounds found in tobacco smoke are also found in vapor, but in much lower concentrations. And perhaps the most dangerous constituent of cigarette smoke with regard to cardiovascular health — carbon monoxide — is not found in e-cig vapor at all.
Fine and ultrafine particles in cigarette smoke are a danger to the cardiovascular system, so naturally some vape-hating researchers have made a point of repeating that there are also particles in e-cig vapor. Stanton Glantz, the longtime anti-smoking (and now anti-vaping) activist from the University of California-San Francisco, has been beating the drum for dangerous ultrafine particles in vapor for years now.
And it’s true that there are particles in e-cig vapor, but they’re liquid droplets, not solid combustion products like the particles in cigarette smoke or diesel exhaust. Now you’d think that Glantz, whose training is in mechanical engineering, would understand the difference between liquid and solid, but maybe not.
“This perhaps explains why he had to leave mechanical engineering (where not knowing the difference between liquids and solids can be rather disastrous) and go into anti-tobacco extremist activism (where it is not such a problem to not know… well, anything),” Carl Phillips wrote.
There has been no research to date showing any provable cardiovascular danger from vaping.