American Heart Association is over-cautious but supportive of e-cigarette use as a substitute for smoking

 

By Dr Farsalinos

The American Heart Association released today a policy statement for e-cigarettes. The main difference from other (mostly respiratory) associations is that in reality they support the use of e-cigarettes as a smoking substitute in smokers who cannot or do not want to quit smoking with other methods. They specifically mention: “If a patient has failed initial treatment, has been intolerant to or refuses to use conventional smoking cessation medication, and wishes to use e-cigarettes to aid quitting, it is reasonable to support the attempt.”

They start the report by describing the health consequences of smoking, while they acknowledge that the reduction in smoking prevalence has been stalled in recent years, showing a much lower rate of decline compared to previous years. Among other information presented to the statement, they mention the lack of smoke, tar and carbon dioxide (due to lack of combustion) in e-cigarettes, and they acknowledge that very low levels of air toxins are produced. Importantly, they address the issue of particle size and composition, with the latter being significantly different from tobacco cigarette smoke. They admit that it is not known whether the type of particles emitted from e-cigarettes have the same toxicity as environmental pollution or cigarette smoke.

Although cautious in expressing themselves (using a lot of “could”, “may” etc), they reproduce the statements about potential adoption by youth and being a gateway to smoking or other harmful substances, However, they accept the evidence showing that consumers are mostly current or former smokers. They propose taxation for e-cigarettes (at levels lower than smoking), in the context of preventing use by youngsters. Moreover, they propose the inclusion of e-cigarettes in smoke-free air laws, although they mentioned that in reality there is second-hand exposure to nicotine only (which has never been a reason for concern even for environmental tobacco exposure). They address the issue of use by youth by supporting the ban of access to minors.

 

The recommendations by AHA are quite different from the review by Grana et al. and closer to the recent reviews by Hajek et al. and by Farsalinos and Polosa. Most importantly, they seem to understand and endorse the view of many of us: the use of e-cigarettes in those unable or unwilling to quit should be supported rather than discouraged. This is a very important message, and I hope more scientific associations will follow this path.

 

 

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