CardioExchange Archive

The recent dramatic rise in popularity of e-cigarettes threatens to reverse hard-fought progress in the war against smoking, according to a new policy statement from the American Heart Association. “E-cigarettes have caused a major shift in the tobacco-control landscape,” said the lead author of the statement, Aruni Bhatnagar, chair of cardiovascular medicine at the University of Louisville.

But the AHA did not completely reject the use of e-cigarettes as an aid to stop smoking. The  statement notes that although the evidence is “sparse” some studies have suggested that e-cigarettes may be equal to or better than nicotine patches to help to quit smoking. The AHA continues to recommend that physicians encourage “proven smoking-cessation strategies as the first line of treatment” but also states that “clinicians should not discourage” e-cigarettes when other methods to quit smoking have failed or when patients want to use e-cigarettes “to help them quit.”

The AHA is especially concerned about the impact on minors of e-cigarettes. The statement expresses “concerns that these products may be another entry point for nicotine addiction among young people.” These concerns are supported by a new study from the CDC published in Nicotine and Tobacco Research that shows a recent tripling in the number of youths who had never smoked a cigarette but who used e-cigarettes, from 79,000 in 2011 to 263,000 in 2013. The AHA wants “strong new regulations to prevent access, sales and marketing of e-cigarettes to youth.”

The AHA reaffirms its position that “e-cigarettes that contain nicotine are tobacco products and should be subject to all laws that apply to these products.” The AHA is also in favor of laws that ban or restrict “the intense marketing and advertising of e-cigarettes,” flavoring of e-cigarettes, and the use of ads utilizing celebrities.

Although e-cigarettes produce fewer toxic substances than cigarettes, the AHA says that “non-smokers may be exposed to nicotine. Unregulated e-cigarettes could potentially turn back the clock to the days when smoking in public was normal behavior, undoing years of work on smoke-free laws and hampering current enforcement.”

Tim McAfee, the Director of CDC’s Office on Smoking and Health, said: “We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development.”