- The true effects of e-cigarettes on human health are just beginning to emerge.
- Risks of vaping include inhaling toxic metals like lead and potentially doubling one’s risk of a heart attack, according to a new study published by UCSF researchers.
- Despite these emerging health concerns, e-cig companies like Juul, the Silicon Valley startup recently valued at $15 billion, are booming.
Smoking kills. No other habit has been so strongly tied to death.
In addition to inhaling burned tobacco and tar, smokers breathe in toxic metals like cadmium and beryllium, as well as metallic elements like nickel and chromium – all of which accumulate naturally in the leaves of the tobacco plant.
It’s no surprise, then, that much of the available evidence suggests that vaping, which involves puffing on vaporized liquid nicotine instead of inhaling burned tobacco, is at least somewhat healthier. But vaping is linked with its own set of health risks, a spate of new research is beginning to reveal. Those risks include inhaling toxic metals like lead, becoming addicted to nicotine, and now, potentially doubling one’s risk of a heart attack.
That latest finding comes from a large study out of the University of California, San Francisco. The study suggests that people who vape every day may face twice the risk of a heart attack compared with people who neither vape nor smoke at all. The research also suggests that daily conventional cigarette smokers face three times the risk of a heart attack, while people who both vape and smoke (so-called “dual users”) face nearly five times the risk.
That should be a significant concern for e-cig users who also smoke cigarettes, Stanton Glantz, the lead author on the paper and the director of the Center for Tobacco Control Research and Education at the University of San Francisco, told Business Insider. It also adds to a growing list of health concerns faced by e-cig companies like Juul, the booming Silicon Valley startup recently valued at $15 billion.
‘We’re the first people to show a long term impact of e-cigarettes’
- Eduardo Munoz/Reuters
Glantz’ recent paper, published on Wednesday in the American Journal of Preventive Medicine, is one of the first studies of its kind to show a long-term health impact of e-cigarettes.
Business Insider spoke with Glantz in February when the peer-reviewed summary of his study was first made public.
He and his research team presented those findings early in an attempt to get the word out about the research – which he found deeply concerning – as soon as possible.
“We’re the first people to show a long term impact of e-cigarettes, and given that it’s consistent with what we know biologically about how vaping effects the heart, we wanted to get this out there,” he said.
Still, the study has a number of limitations, most notably the fact that it could not conclude that vaping (or even smoking, for that matter) caused heart attacks – only that the two were linked.
To arrive at the findings, Glantz and his research team looked at national survey data on 70,000 Americans which asked people about their use of e-cigarettes and regular cigarettes. It also asked if they’d ever suffered a heart attack. After controlling for factors that could muddle their results, like hypertension, the researchers found that people who vaped every day were twice as likely to have suffered a heart attack as people who didn’t vape or smoke at all. Daily smokers were three times as likely as non-smokers to have suffered a heart attack.
The people most at risk, however, are “dual users,” or people who both vape and smoke. Dual users faced approximately five times the risk of a heart attack as those who took up neither habit, the study suggested.
Other studies in animals and cells have suggested that vaping could stiffen the heart and blood vessels, potentially creating an increased risk of heart disease and heart attacks, but this was the first to line up those limited findings with actual health impacts in humans.
People who vape and smoke are most at risk
- Spencer Platt/Getty
Many e-cig manufacturers promote their devices as a tool for either quitting smoking or for “switching” from smoking conventional cigarettes to vaping, which is generally seen as less harmful. Juul, the San Francisco-based startup behind the most popular e-cig in America, encourages consumers to “make the switch” from traditional cigarettes to the Juul.
But the new study suggests that the people most vulnerable to an increase in heart attacks are those who make both smoking and vaping a daily habit. Glantz said this group of people also represent the largest population of e-cig users.
“E-cigarettes are widely promoted as a smoking cessation aid but for some, they actually make it harder to quit, so most people end up doing both,” Glantz said. “This is the dominant use.”
Juul, which was recently valued at $15 billion and is already rapidly expanding both in the US and internationally, has come under fire for a range of other health issues, namely its popularity among teens who are particularly susceptible to nicotine addiction.
“At Juul Labs, our definition of switching is aligned with the American Cancer Society, National Academy of Science, and Public Health England: Smokers should switch completely away from combustible tobacco,” a representative for the company told Business Insider.
“We are committed to helping current adult smokers who want to end their relationship with combustible cigarettes.”
Snowballing evidence of health concerns tied to vaping
- California Department of Public Health
Evidence still suggests that inhaling vapor is healthier than breathing in burned tobacco. Still, researchers urge people to recognize that e-cigs come with their own set of health concerns.
Chief among those issues is the high concentration of nicotine in e-cig fluid. This may be part of the reason why teens who vape are seven times more likely to smoke regular cigarettes than young people who never use e-cigs.
Ana Rule, a professor of environmental health and engineering at Johns Hopkins University, said the makers of these devices fail to address “the increased risk to this huge market they are creating among teenagers and young adults that never have smoked, and would have never even considered smoking” had they not vaped.
Researchers are also not convinced that e-cigs actually help adult smokers quit.
So far, the evidence suggests they don’t. In January, a study in the journal The Lancet found that e-cigs were linked with “significantly less quitting” among smokers. Several months later, a study in the Annals of Internal Medicine found that e-cig users were less likely than non-vapers to abstain from tobacco use over six months. And a study published in the journal PLOS One this month found no evidence that vaping helped adult smokers quit.
Nicholas Chadi, a clinical pediatrics fellow at Boston Children’s Hospital, spoke about the Juul at the American Society of Addiction Medicine’s annual conference in April.
“After only a few months of using nicotine, [these teens] describe cravings, sometimes intense ones. Sometimes they also lose their hopes of being able to quit,” Chadi said.
For these reasons, several nonprofit anti-tobacco agencies strongly oppose Juul, including the nonprofit Campaign for Tobacco-Free Kids and the California Department of Public Health. On Tuesday, Israel became the first country to ban Juul devices entirely, citing health concerns linked with the their high nicotine content. In a statement, Israel’s Health Ministry said the devices pose “a grave risk to public health.”
Let’s get physical isn’t just a catchy line from an Olivia Newton John song – it’s a health intervention.
Exercise is increasingly being recognized as the closest thing to a miracle drug that we have. Not only does regular movement appear to benefit our mind and body, it also seems to protect us from many aspects of aging’s slow wear and tear.
For a new study published in the Journal of the American Heart Association, researchers found that older people who spent less time sitting and more time moving had fewer signs of encroaching heart disease.
The scientists had 1,600 British volunteers between the ages of 60 to 64 wear heart-rate sensors for five days. They analyzed the participants’ activity levels and compared them to indicators of heart disease such as cholesterol precursors and a substance called interleukin-6. Overall, the participants with more activity had lower levels of all of the negative biomarkers.
The effects were even noticeable when the researchers looked at participants’ activity in 10-minute chunks. Every 10 minutes spent doing some kind of movement – whether it was walking, playing tennis, or gardening – was linked with measurable improvements in at least one type of biomarker related to heart health.
Conversely, every 10 minutes spent sitting was tied to worse biomarker results.
These results add to a growing body of evidence that suggests physical activity can lower the risk of heart disease.
“It’s important to replace time spent sedentary with any intensity level of activity,” Ahmed Elhakeem, the study’s author and a professor of epidemiology at the University of Bristol, said in a statement.
2 forms of exercise may be the key to keeping your heart and brain young
- Al Bello/Getty Images
This isn’t the first time that two forms of exercise – cardio and strength training – have been tied to anti-aging benefits. Aerobic exercise, or cardio, is the type of workout that gets your heart pumping and sweat flowing, while strength training helps keep aging muscles from weakening over time.
Both of those types of exercise are important for the heart, parts of which can grow stiff with age. The left chamber of the heart, which plays a key role in supplying the body with freshly-oxygenated blood, is especially susceptible to age-related damage.
A recent study published in January in the journal Circulation found that adults who practiced supervised exercise four to five days per week saw significant improvements in their heart’s performance over two years when compared to a control group that only did basic stretching and balancing moves. Those results suggest that some stiffening in the heart can be prevented or even reversed with regular aerobic exercise.
“Based on a series of studies performed by our team over the past five years, this ‘dose’ of exercise has become my prescription for life,” said Benjamin Levine, the author of the study and a professor of internal medicine at the University of Texas Southwestern.
Regular movement has benefits for the aging brain as well.
In May, a large review of nearly 100 studies published in the journal Neurology: Clinical Practice found that older folks who got roughly 40 minutes of exercise three times per week showed significant cognitive advantages compared with people who did less exercise or none at all.
Those benefits included better processing speed and superior performance on tests that measure skills like time management and the ability to pay attention.
“This is evidence that you can actually turn back the clock of aging in your brain by adopting a regular exercise regimen,” said study author Joyce Gomes-Osman, a rehabilitation scientist at the University of Miami’s Miller School of Medicine.
The intensity of a workout matters less than moving regularly
A growing body of evidence suggests that the time you spend on a single workout matters less than the total time you spend at the gym over long periods. That means whether your latest workout was five or 50 minutes is less important than whether you hit the track or pool regularly – at least several times a week.
When it comes to the heart benefits observed in their latest study, the American Heart Association recommends getting at least 150 minutes per week of moderate-intensity exercise like walking or 75 minutes per week of vigorous-intensity exercises like kickboxing, along with muscle-strengthening exercises two or more days a week.
If you’re curious about how to get started, we recently spoke to a physical trainer and exercise scientist who laid out an easy weekly plan. Try it for yourself!
- Cardio could be the closest thing to a miracle drug that we have, but doing it shouldn’t take a whole day.
- Instead, the available evidence suggests there’s an ideal window for exercises like cycling, swimming, or brisk walking – and it’s under an hour.
- All of these moves raise your heart rate and get you moving and sweating in a way that appears to benefit our moods and muscles more than other workouts focused solely on weight-lifting or stretching.
Cardio could be the closest thing to a miracle drug that we have, but doing it shouldn’t take a whole day.
Instead, the available evidence suggests that committing 30 to 45 minutes daily to exercises like cycling, swimming, or brisk walking is the ideal way to reap the maximum health benefits for your body and brain.
These moves raise your heart rate and get you moving and sweating in a way that appears to benefit our moods and muscles more than other workouts focused solely on weight lifting or stretching. To do them correctly, scientists have a few pointers that go beyond simply clocking in at 30 minutes.
Why cardio is so key to wellbeing
- Unsplash / Haley Phelps
A growing body of research suggests that when we commit to regular workouts that raise our heart rates and get us moving and sweating for a sustained period of time, magical things happen to the body and brain.
We think more clearly, feel better overall, and protect our brains against some of the cognitive decline that occurs with age.
“Aerobic exercise … has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress,” the authors of an article in the Harvard Medical School blog “Mind and Mood” wrote.
In addition to the mental benefits, our muscles get toned, our hearts become stronger and more protected from disease, and we can even become more flexible, depending on the exercise.
Researchers still aren’t sure why this type of exercise offers such a significant boost to our brain and body, but some studies suggest it has to do with increased blood flow, which provides our minds with fresh energy and oxygen.
One recent study in older women who displayed potential symptoms of dementia also found that aerobic exercise was linked with an increase in the size of the hippocampus, a brain area involved in learning and memory.
Still another reason may relate to cardio’s ability to help reduce levels of the body’s natural stress hormones, such as adrenaline and cortisol, according to a recent study in the Journal of Physical Therapy Science.
Half an hour is where the magic happens
All it takes to begin to see these benefits is roughly 30 minutes, according to several recent studies.
One recent paper looked at the exercise habits of hundreds of breast cancer survivors who were experiencing symptoms like “chemo brain,” which involves memory loss and trouble focusing. The researchers found that as little as 30 minutes of an aerobic exercise like walking was linked with significantly better performance on cognitive quizzes.
Another study published in May provided some additional support for that research – it found that in adults aged 60-88, walking for 30 minutes four days a week for 12 weeks appeared to strengthen connectivity in a region of the brain where weakened connections have been linked to memory loss.
Similarly, a pilot study in people with severe depression found that just 30 minutes of treadmill walking for 10 consecutive days appeared to be “sufficient to produce a clinically relevant and statistically significant reduction in depression.”
Other research suggests it might be better to do cardio for a few minutes longer – but nothing over an hour was needed.
A study in the British Medical Journal found that in adults over 50, the best results for the brain appeared to come from a routine that combined aerobic exercises with resistance training (i.e. muscle-building exercises like planks and push-ups) and lasted at least 45 minutes.
That means for the maximum benefits to your body and brain, you don’t need to spend hours at the gym. Find a window of time between 30 and 45 minutes that you can do whenever you have the most energy, and commit to it a few times a week.
Around a quarter of us – one in four – walk around with a gap in our hearts. Yes, a literal gap.
It is a remnant of our time in the womb, when when the fetal lung is not yet matured and functioning.
As consultant interventional cardiologist Datuk Dr Yap Yee Guan explains, this is because we received oxygenated blood straight from our mother’s uterus via the umbilical cord.
Therefore, there was no need for our foetal selves to pump blood to our lungs to get oxygenated. In any case, we cannot breathe in the womb as amniotic fluid surrounds us.
A gap in the incompletely-formed atrial septum, which forms the border between the left and right atriums of our heart, provided a natural shortcut to bypass the unneeded right ventricle.
The right ventricle serves to pump deoxygenated blood from the body to our lungs to get oxygenated again. Usually, this gap – called the foramen ovale – closes up at birth, due to certain biochemical and pressure changes in the heart that happen then.
The upper and lower septal portions fuse together to form a continuous wall – the septum, says Dr Yap.
However, he adds: “Even though that is what is suppose to happen, in a quarter of adults – 25% of the general population – this septum remains open.”
He notes that this situation, called a patent foramen ovale (PFO), is not the same as a hole in the heart, which is called an atrial septal defect.
With the latter, there is a literal hole in the heart as the two septal portions remain separate, whereas the former is more of a gap caused by overlapping sections of the atrial septum that flap apart when the atriums contract, because they have not fused together.
The good news is that most people with PFOs usually do not experience any problems due to this gap. However, it has been found that a high percentage of patients who have been hit by a cryptogenic stroke have a PFO.
Says Dr Yap: “Historically, we’ve found that young people with stroke or people with cryptogenic stroke, a large proportion of them – 40% – will have a PFO, as opposed to 25% of the general population.
“It has been suggested previously that perhaps there is an association between young people (roughly those less than 60 years of age) with stroke with no known cause and this condition (PFO).”
- These echocardiogram stills show a PFO (top, in circle) and a closed PFO held together by the PFO closure device (bottom, in circle). — DATUK DR YAP YEE GUAN
A cryptogenic stroke is a stroke for which no cause or origin can be identified.
About 20%-30% of ischaemic strokes, which are caused by a blood clot blocking an artery in the brain and which comprise about 80% of all strokes, are cryptogenic strokes. It tends to occur in younger people as they are less likely to have the known risk factors or medical conditions that can precipitate a stroke.
Dr Yap notes that it is very important to rule out all other more common causes of stroke before looking for a PFO. — M. AZHAR ARIF/The Star
Having a PFO may increase the risk of having a stroke as a clot that comes from elsewhere in the body can slip through the gap in the atrial septum from the right atrium to the left atrium, and from there to the brain. (All veins eventually lead to the right atrium.)
Dr Yap notes that this association is probably not very surprising as there have been echocardiograms of patients with cryptogenic stroke where blood clots can be seen at the PFO, waiting to get across to the left atrium.
In addition, the increasing prevalence of deep vein thrombosis (DVT), where blood clots form in our veins, has also increased the chances of a younger person with a PFO being affected by stroke.
The clot in the right atrium is most likely to be from DVT, where blood clots form in our veins, then travel to the right side of the heart and lung, resulting in the increased chance of a younger person with a PFO being affected by stroke.
It is estimated that around 10% of general population have experienced DVT, as one of its risk factors is inactivity, e.g. prolonged sitting without moving, like during long-haul flights or at work or play in front of the computer – activities that are becoming increasingly common.
While there is not much one can do to prevent a cryptogenic stroke, there are ways to prevent a recurrent stroke – and all stroke patients have a higher risk of suffering from another stroke.
An effective device
Typically, cryptogenic stroke patients were treated with antiplatelet or anticoagulant therapy, colloquially known as blood-thinners.
However, Dr Yap shares that recent studies have shown that a device, known as a PFO closure device, can decrease the risk of a repeated stroke in cryptogenic stroke patients with a PFO significantly.
The results of three large clinical trials comparing the use of the device versus antiplatelet or anticoagulant therapy in such patients were published last year.
The Reduce trial showed that the risk of a recurrent stroke was decreased by 77% in the group with the device (1.4% absolute risk), compared to those on medication (5.4% absolute risk), after an average of 3.2 years follow-up.
The Close trial saw 6% of those on medication experiencing a second stroke, versus none with the device, after an average of 5.3 years.
And a sub-study of the earlier published Respect trial looking at patients after an average of 5.9 years, found a 45% decrease in risk of a recurrent stroke in the group with the device.
The PFO closure device comprises of two elastic discs made out of a mesh of nitinol (nickel titanium) and dacron cloth, connected with a tether. The two discs block off the gap on either side of the atrial septum.
The PFO closure device is extremely elastic, which means that it can be squeezed into very small spaces, like the catheter that carries it to the heart via the body’s veins, and easily return to its normal shape. — M. AZHAR ARIF/The Star
Dr Yap explains that inserting and placing the device, though a relatively straightforward procedure, requires a highly-skilled interventional cardiologist who has a good understanding of anatomy and the technical challenges of performing the procedure.
It is done by inserting a catheter into the femoral vein of the leg, and passing it all the way up to the right atrium of the heart and through the PFO to the left atrium.
The device is then inserted and passed through the catheter, and deployed when in the right position.
“The procedure is very safe,” he says. “The only thing is that by closing the PFO, there is a slightly higher risk of a transient condition called paroxysmal atrial fibrillation, which is an irregular heartbeat. But most of the time, this is self-limiting – it will disappear by itself.”
While a PFO as the cause of a cryptogenic stroke is easily treatable, Dr Yap stresses that it is essential for someone with a stroke to receive a thorough evaluation from a neurologist – the medical specialist in stroke – to rule out all other more known causes of stroke first.
It is the neurologist who will refer the patient to the cardiologist to investigate the possibility of a previously-unknown PFO, after ruling out all other causes.
Dr Yap emphasises that younger stroke patients have a long life ahead of them, and every possible effort to reduce their risk of a second stroke should be made, especially with the availability of such an effective treatment.
This article is courtesy of Sunway Medical Centre.