Study reports higher smoking cessation through e-cigarette use

Smoking continues to be an important risk factor for coronary heart disease and acute heart attack with a subsequent high mortality rate. One way to make it easier to quit nicotine addiction could be to quit smoking with an e-cigarette.

German Society of Cardiology is skeptical about results

Smoking continues to be an important risk factor for coronary heart disease and acute heart attack with a subsequent high mortality rate. Once people start nicotine use, many attempts may follow to get rid of it. One way to make it easier to quit tobacco addiction could be to quit smoking with an e-cigarette.

An English study recently published in the New England Journal of Medicine (source 1) examined whether e-cigarette smoking cessation is really a suitable method and how promising it is. The result: Long-time smokers, who were willing to quit smoking, were able to quit smoking with the e-cigarette twice as often as with nicotine substitutes. 

In the study 886  smokers, with an average age of 41, were divided into two groups after a personal consultation. One group received a starter pack with e-cigarette and a nicotine-containing liquid, further units for optional refilling followed. The second group was equipped with other nicotine substitutes. All participants were also encouraged to participate in regular behavioral therapy. After 12 months, 18% of e-cigarette smokers were tobacco abstinent. Those who wanted to stop smoking with other nicotine substitutes only showed 9.9% of this abstinence.

Results on long-term effects are not well-substantiated

Nevertheless, the study results are to be taken with caution, as considered by experts from the German Society of Cardiology (German acronym: DGK). for them, it is important to notice that in this study, the majority of the test subjects of the E-cigarette group did not do without smoking on a long-term basis, and 80% of the E-cigarette users remained consumers. “As most patients changed to the E-Zigarette, is this a real exit (12 months) or did complete abstinence not take place?, explains Professor Dr. Rainer Hambrecht, chairman of the DGK prevention project group. Prof. Dr. Harm Wienbergen, adds: "It is particularly alarming that so far no results are available over the long-term consequences of E-cigarettes, while instead there are first concerning references to serious long term damage by E-cigarettes” (sources 2 and 3).

For example, a US study showed that the consumption of nicotine-containing e-cigarette liquids has effects on bronchial epithelial cells that are otherwise only observed in patients suffering from chronic obstructive pulmonary disease (COPD). At the beginning of 2019, the American Heart Association had already warned in a press release that the consumption of E-cigarettes had increased the rate of strokes and accompanying heart illnesses (source 4).

The DGK cardiologists widen their concern over the susceptibility of young people to e-cigarette consumption and more so, their use in young people can open the path for the use of conventional cigarettes (source 5). Therefore, they call instead for stronger national regulations over the sales and advertising of e-cigarettes and their accessories.

1. Hajek P et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med 2019;380:629-637.
2. Garcia-Arcos I et al. Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner. Thorax 2016;71:1119-1129.
3. Ghosh A et al. Chronic E-Cigarette Exposure Alters the Human Bronchial Epithelial Proteome. On J Respir Crit Care Med 2018;198:67-76.
5. Walley SC et al. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. Pediatrics 2019;143:e20182741.