Electronic cigarettes: Replacing one evil with another?

Abstract

Cigarette smoking is still the most important avoidable cardiovascular risk factor. The World Health Organization estimates that 20.2% (34.1% male, 6.1% females) of the world’s population aged ≥15 years were current smokers in 2015. Within non-communicable diseases, tobacco use is estimated to be responsible for 10% of all deaths from cardiovascular diseases, 22% of all cancer deaths and 36% of all deaths from diseases of the respiratory system. Recent data suggest that tobacco smoking may also increase the risk of atrial fibrillation. Electronic cigarettes may be an effective way to assist with smoking cessation. A recent randomized trial demonstrated that electronic cigarettes were more effective for smoking cessation at one year than nicotine replacement therapy. However, the smoking cessation rate was only 18%, and among participants with one-year abstinence, 80% of those in the e-cigarette group were still using electronic cigarettes. This brings up the question of whether this approach merely replaces one evil with another. Clearly, knowledge on the safety of electronic cigarettes is critical in answering this question.