Is smoking cigarettes worse than vaping? And electronic cigarettes hurt more or less water pipes (or waterpipe or hookah or shisha, however you call them)? Well, for the first time, a study compares the damage caused by three different modes of smoking by analyzing the effects on the functionality of the endothelium, the layer of cells that lines the blood vessels, and on the risk of falling ill with oncological diseases, respiratory, cardiovascular, stroke and heart attack.
A revision
The research, published on European Heart Journal, is a systematic review of the available evidence of the impact of toxic substances produced by the three types of smoke on our body. The conclusion – to summarize – was that cigarettes, electronic cigarettes or water pipes make the arteries less elastic and more rigid and cause inflammation and damage to DNA, with a consequent wide range of health problems. Not only that: the authors also say that smoking and vaping can contribute to increasing the susceptibility to coronavirus infection, and the risk of experiencing more serious symptoms and death for Covid-19, and they associate themselves with the WHO, the CoC, the U.S. Centers for Disease Control and Prevention, the FDA and the European Society of Cardiology that urge smokers to try to quit smoking, regardless of what and how they smoke.
Bpco and tumors
The results of the review? Therefore, compared to those who do not smoke, those who smoke cigarettes have an increased risk of chronic obstructive pulmonary disease (BPCO) by 704%; those who use water pipes of 218% while in the vapors of electronic cigarettes of 194%. But now we come to lung cancer: cigarettes and water pipes have increased the risk by 1210% and 122% respectively while the degree of evidence relating to electronic cigarettes has not been sufficient to draw reliable conclusions.
The arteries
The authors also examined the relationship between classic smoking, vaping and arterial stiffness. Arterial stiffness (i.e. reduced elasticity of the arteries) is in fact an important prognostic indicator of the risk of pathologies or cardiac events and strokes. Well, compared to non-smokers, in classic cigarette smokers arterial stiffness was increased by 10%, in water pipe users by 9% and in e-cig users by 7%. Overall, traditional cigarettes were therefore more harmful than electronic cigarettes and water pipes. However – the authors reasoned – while we have many great studies on the harmful effects of blondes, it is not the same for water pipes (not very common in Italy and for which we do not have certain national data, but they are very common in USA and Europe, especially among young people) and electronic cigarettes, consequently the evidence on these two types of smoke has been more variable. In fact, the long-term effects of water pipes and electronic cigarettes need to be studied more thoroughly, they say. In the meantime, “smoking water pipes is no less harmful than tobacco smoke and therefore cannot be considered a healthy alternative”.
Oxidative stress
“Our work – said the first author of the review, Thomas Munzel, of the Cardiology department of the University of Mainz, Germany – focuses mainly on the negative effects of these three smoking and vaping techniques on endothelial dysfunction (an alteration of the tissue that internally covers the vessels with consequent loss of some structural and functional characteristics of the cells, ed), on the relationship with oxidative stress and secondly with clinical conditions “. All three forms of smoke and vaping – Münzel explained – lead to an increase in the production of free radicals and the breakdown of NO or nitrogen monoxide (or nitric oxide), a molecule that is released by endothelial cells and which has the function of making blood vessels more elastic, more capable of dilating and protecting against inflammation and occlusion of the arteries.
The harmful substances
Among the harmful substances present in the e-cig vapor is formaldehyde and acrolein, transition metals and volatile organic compounds, all molecules, or elements, whose ability to damage cells is known. On the contrary – Münzel and colleagues reported – tobacco cigarettes and water pipe smoke contain a much more complex mixture of harmful chemicals. Waterpipe smoke contains solid particulate matter which is also present, in lower concentrations, in cigarette smoke. Nicotine, which is the main compound of the tobacco plant and which is addictive, is found everywhere, in all three products.
Toxic profiles
They are therefore superimposable and different toxic profiles, “which may be a key to understanding the similarities and differences of the negative effects of smoking and vaping on health, and which should be further investigated with other future studies”, was the consideration by Munzel.
READ also: Australia’s crusade against e-cigarettes
Advertising
The study provides maps that indicate the different approaches in the EU and US to advertising cigarettes and tobacco products: radio and TV is not allowed throughout the European Union. Some countries, such as Slovenia and Norway, have strict laws that prohibit all types of advertising, even in stores. Germany is the only country in the Union where tobacco products, including e-cigarettes, can be advertised on billboards. In the United States, advertising on billboards is permitted for both tobacco products and electronic cigarettes “which – said Münzel – are considered mostly tobacco products, but the laws on their advertising are not always clear. Although electronic cigarettes seem less harmful than tobacco cigarettes, “there is growing evidence that e-cig can also cause side effects in the lungs, heart and blood vessels and that the use of electronic cigarettes can also raise the Covid-19 risk “.
About Covid-19, an analysis of the relationship between smoke-vaping and Covid-19 could not be missing from the study. “As the WHO points out – the authors write in the text – cigarette smoking and waterpipe can contribute to increasing the severity of the symptoms of Covid-19 (…) including access to intensive care”. In this regard there is a note from our Higher Institute of Health that is worth mentioning that says that one third more of Covid-19 positive smokers at hospitalization present a more serious clinical situation than non-smokers, and for the risk of needing intensive care and mechanical ventilation is more than double (Italian March data).
There is no doubt that smoking cessation is and will remain the most effective approach for preventing smoking-related cardiovascular and respiratory diseases, but “this could be even more important – is the reflection of the researchers – in the light of the COVID pandemic -19 because the use of tobacco products probably increases the risk of complications (…) “.
The numbers
According to WHO data, tobacco smoke is the greatest threat to health and the first risk factor of chronic non-communicable diseases worldwide, with about one billion smokers worldwide, of which about 80% live in low and middle income countries. 70% of consumers start smoking before the age of 18 and 94% before the age of 25.
According to ISTAT data in Italy smokers aged 14 and over are just under 10 million. Smoking is most common between the ages of 20 and 44. It is estimated that over 93 thousand deaths per year are attributable to tobacco smoke, more than 25% in the 35-65 age group. Again in Italy the mortality and incidence (the number of cases per year) of lung cancer, one of the main smoking-related diseases, are decreasing among men but increasing among women, for whom this pathology has overcome stomach cancer, becoming the third leading cause of cancer death after breast and colorectal cancer.
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