The dual use of cigarettes and e-cigarettes carries the same heart disease risk as smoking alone. That is the clear warning from a major new study published in Circulation, the peer-reviewed journal of the American Heart Association. Many smokers pick up vaping hoping it will help them cut down. But most never fully quit cigarettes. They end up doing both, and their heart pays the same price.

What the Research Found About Dual Use of Cigarettes and E-Cigarettes

Researchers drew on data from the Population Assessment of Tobacco and Health (PATH) Study. This nationally representative US survey tracked more than 24,000 adults across five annual waves between 2013 and 2019. The study split participants into four groups: non-users, exclusive e-cigarette users, exclusive cigarette smokers, and those practising the dual use of cigarettes and e-cigarettes.

The team recorded self-reported cardiovascular events over the previous 12 months. These included heart attack, bypass surgery, heart failure and stroke. In total, researchers logged more than 1,480 cases of any cardiovascular disease and over 500 cases of heart attack, heart failure or stroke.

The results were straightforward. People who were smoking and vaping at the same time showed no meaningful reduction in cardiovascular disease risk. Compared to exclusive cigarette smokers, dual users had no significant difference in risk for heart attack, heart failure or stroke.

“The fact that dual use had similar cardiovascular disease risk to smoking cigarettes only is an important finding,” said Dr Andrew C. Stokes, assistant professor at Boston University School of Public Health and senior author of the study. “Many Americans take up e-cigarettes believing they carry a lower risk. It is common for people to try switching and get caught in limbo using both products.”

The Scale of the Problem and the Risk to Young People

Cigarette smoking remains one of the leading causes of preventable death in the United States. The American Heart Association reports that nearly one in five US deaths each year links to cigarette smoking and secondhand smoke exposure.

The youth figures in this study are particularly alarming. Among exclusive e-cigarette users, 62% were under 35. Among dual users, 54% fell into that same age group. Vaping is not simply replacing cigarettes among existing smokers. It is pulling a new, younger generation into nicotine addiction.

Some early figures from the study pointed to a potential difference in cardiovascular event rates between exclusive e-cigarette users and cigarette smokers. But researchers urged caution. The e-cigarette sample was small. The data relied on self-reporting. Most importantly, the difference did not hold up when researchers looked specifically at heart attack, heart failure or stroke. The study authors concluded that far more evidence is needed, and that nobody should treat e-cigarettes as a safe or lower-risk alternative.

Smoking and Vaping at the Same Time: A False Sense of Progress

This research raises serious concerns about how people actually use e-cigarettes. Rather than serving as a step toward quitting, vaping appears to create a new category of user. People add it on top of their cigarette habit instead of replacing it.

“Many smokers who try e-cigarettes for cessation continue using both products,” Dr Stokes said. “We are concerned that recommending e-cigarettes for smoking cessation may increase dual use and encourage young adults who have never smoked to start.”

Rose Marie Robertson, MD, deputy chief science and medical officer of the American Heart Association, reinforced this point. “E-cigarettes contain addictive nicotine and toxic chemicals. These may harm the cardiovascular system and overall health.”

The FDA has not approved e-cigarettes as a smoking cessation tool. Anyone who wants to quit should speak to their doctor about evidence-based methods that carry FDA approval.

Why Complete Cessation Is the Only Safe Path

The dual use of cigarettes and e-cigarettes is not a halfway house to better health. For anyone who thinks adding vaping to their routine reduces their risk, this study delivers a clear reality check.

Dr Robertson noted the limitations of the current data. The PATH study covers a short timeframe. Event rates remain low, especially among younger participants. Long-term evidence on vaping simply does not yet exist in the way it does for traditional cigarettes.

“Even with traditional cigarettes, decades of surveillance were needed to confirm the harm,” Dr Robertson said. “Since e-cigarette use is still relatively new, we look forward to more data from ongoing studies.”

What this study makes plain is that there is no safer nicotine product. Neither cigarettes alone, nor smoking and vaping at the same time, offer a safe path. Complete cessation, with proper medical support and FDA-approved methods, remains the only responsible choice for anyone serious about their health.

Reference: Berlowitz, J.B., et al. (2022). E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019. Circulation. doi.org/10.1161/CIRCULATIONAHA.121.057369

Source: news-medical