Interviewer: How e-cigarettes affect your heart and it's not in a good way, and it might not be better than smoking after all. We're going to find out more about that next with cardiologist, Dr. John Ryan on The Scope.
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Before we get into the conversation about e-cigarettes and how they affect your heart health, I think it's important that we say that cigarettes and e-cigarettes are linked to many different health problems. But today, we're just focusing on one particular and that's issues related to the heart. So, Dr. Ryan, how do e-cigarettes affect a person's heart health and are the threats real?
How Does Smoking Affect Your Heart?
Dr. Ryan: I think the threats are real. I think the concerns are legitimate. One particular concern with e-cigarettes is that it's really re-normalizing cigarette smoking, nicotine consumption, and tobacco use within North America. Some of it, the science is uncertain. We are not sure of the long-term effects of e-cigarettes, either on heart or lung disease. And then legitimate concerns get raised because of this chronic exposure to nicotine, chronic and also varying exposure to nicotine. One of the particular issues there seems to be marked variation in how much nicotine is being consumed with each vape.
Interviewer: Because when you get the little vapor things, it tells you how many milligrams per whatever, but that's not regulated so we don't know if that's accurate or not.
Dr. Ryan: Exactly. And the anticipated is .05 is what's often quoted. It can really range up to 15 whereas where your cigarettes would be about two to three. So in that regard, there's variation there that's concerning. Also, some of the physiologic effects that e-cigarettes and nicotine consumption, in general, are concerning, in particular, high blood pressure, fast heart rate, endothelial dysfunction, which is the lining of the blood vessels of the heart, in particular, which can be a trigger for atherosclerosis and coronary artery disease.
And all of these things are affected by the nicotine consumption and, in particular, by the e-cigarette nicotine consumption as well as other chemicals that are in the e-cigarettes. And as you rightly pointed out, the regulation of this is difficult and not as robust as many physicians and scientists would like. And that just raises further concerns.
Nicotine and Heart Health
Interviewer: So you mentioned a lot of different bad things that can happen from e-cigarettes, and it's related to nicotine primarily, the raising your heart rate, the blood pressure, your blood vessels narrowing, high risk of hardening of the arteries. What does that do, then, that causes heart failure or heart attack or stroke?
Dr. Ryan: So a lot of it we don't know, first of all. That specifically raises concerns, but the issues, in particular, that are raised with high blood pressure, with fast heart rates, with narrowing of the blood vessels of the heart, the coronary arteries, as you mentioned, this puts extra strain on the heart. The heart obviously depends on blood flow in order to get oxygen, and in the setting of high blood pressure, fast heart rate, decreased vessel size, you do raise the risk of having a heart attack.
So the essential concern, in particular, is for heart attacks, that the use of nicotine, e-cigarettes, and cigarettes raises your risk of having a heart attack. And also, it's not necessary, and that's where I got back to the normalization of tobacco consumption and nicotine consumption within North America. This is not a necessary thing that we need to do. This distinguishes it from . . . and there's controversy of this as well, but diet consumption, fat consumption, etc. However, we do need to eat. We don't need to smoke and we don't need to vape.
Interviewer: So for sure, we know nicotine causes these negative effects to the heart.
Dr. Ryan: Exactly.
Popcorn Lung
Interviewer: What about the other chemicals, like . . . I've heard the flavoring chemicals. Even if you're getting the dose without the nicotine, they've found that it can cause other diseases.
Dr. Ryan: Yeah, so the flavoring has recently been associated with what's called popcorn lung or bronchiolitis obliterans, which is a form of inflammatory and fibrotic lung disease. The reason this raises concerns is, first of all, lung disease, therefore, puts a strain on your heart. And secondly, if there's chronic inflammation, which we see in the setting of poor air quality and stress, it can result in triggering heart attacks or heart disease. So I think there are two main concerns with the chemicals that you bring up in terms of e-cigarettes.
Interviewer: If you've got a patient that's right in front of you now that smoked e-cigarettes, how would you convince them that they shouldn't? Because a lot of people get enjoyment out of it, or it's an addictive habit that they can't stop. It takes a lot of willpower to quit.
Dr. Ryan: Being sensitive enough in terms of convincing people to do things. Ultimately, I think you have to introduce the risks associated with the disease, the risks associated with the risk factors, and hope that they make an informed, educated decision about their habits. And so I try and present to them the uncertainty about e-cigarettes. I try to present them with some of the concerns that I have about e-cigarettes and nicotine consumption in general. And then, hopefully, when they leave the clinic and when they go home, they're able to access resources themselves and make good decisions themselves and be comfortable with the decisions they're making.
Interviewer: And I think, essentially, it comes down to this is something that you don't have to do to your heart.
Dr. Ryan: Exactly, yeah. You don't have to do it to your heart. You don't have to do it to your lungs.
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updated: January 8, 2019
originally published: January 26, 2016
