First Comparison: Health Risks of Cigarettes, E-Cigarettes, and Hookah

Introduction: Smoking is a leading cause of non-communicable diseases worldwide and a major risk factor for cardiovascular diseases (CVD) and lung diseases. In recent years, e-cigarettes have become increasingly popular, especially among the younger generation. However, there is considerable debate regarding the harm of e-cigarettes compared to traditional cigarettes. Recently, German researchers conducted the first comparison of the health risks of cigarettes, e-cigarettes, and hookah.

Currently, six of the top eight causes of death worldwide are related to smoking. The prevalence of tobacco is one of the greatest threats to public health and a primary cause of morbidity and mortality from cardiovascular diseases. Recently, German researchers conducted the first comparison of the health risks of cigarettes, e-cigarettes, and hookah, finding that all three can cause arterial stiffness, inflammation, and DNA damage, leading to various health issues.

This study, led by Professor Thomas Münzel from the Department of Cardiology at the Mainz University Medical Center in Germany, was published on June 25 in the European Heart Journal. The title is "Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes".
 

In this study, scientists explored for the first time the effects of cigarettes, e-cigarettes, and hookah on human health and endothelial cell function. They reviewed existing evidence of harmful chemicals produced by smoking and the mechanisms by which smoking affects the body. The researchers also compared the effects of the three types of smoking on diseases such as stroke, heart disease, and lung cancer.

Previous studies have shown that smoking leads to endothelial dysfunction and vascular damage. Long-term exposure to tobacco smoke impairs acetylcholine-dependent vasodilation and coronary blood flow, which is associated with elevated plasma cholesterol levels. The research team found that, overall, cigarettes are more harmful than e-cigarettes. However, there is insufficient data on the effects of hookah and e-cigarettes on endothelial dysfunction. The researchers stated that the long-term effects of hookah and e-cigarettes require further investigation. They also wrote, "The harms of hookah are not less than those of cigarettes, so hookah should not be considered a healthy alternative."
  The effects of the three types of smoking on endothelial function and antioxidant intervention

The chronic and acute effects of the three types of smoking on animal endothelial function

The researchers reviewed a series of studies that provided evidence for the harmfulness of the three types of smoking. Compared to non-smokers, smoking increases the risk of chronic obstructive pulmonary disease (COPD) by 704% for cigarettes, 218% for hookah, and 194% for e-cigarettes; cigarettes and hookah increase the risk of lung cancer by 1210% and 122%, respectively, while data on e-cigarettes is insufficient to draw reliable conclusions.

They also studied the effects of the three types of smoking on atherosclerosis, which is an important prognostic indicator of the risk of heart disease and stroke. Compared to non-smokers, smoking increases the risk of atherosclerosis by 10% for cigarettes, 9% for hookah, and 7% for e-cigarettes.

The first author of this review, Professor Thomas Münzel from the Department of Cardiology at the Mainz University Medical Center, stated: "Our review primarily focuses on the adverse effects of these three types of smoking on endothelial dysfunction and their relationship with oxidative stress, which is associated with clinical diseases. All three types of smoking lead to an increase in reactive oxygen species (such as superoxide) in vascular tissues. This decomposes nitric oxide released by endothelial cells, which is crucial for helping blood vessels dilate and preventing inflammation and arterial blockage."
 

The mechanisms of smoking's effects on endothelial function

The researchers noted that the main toxic chemicals in e-cigarette vapor include formaldehyde and acrolein, as well as trace amounts of transition metals and volatile organic compounds (VOCs), all of which can damage cells. In contrast, cigarettes and hookah contain a more complex array of harmful chemicals. Hookah smoke contains solid particulate matter, primarily from the charcoal used to burn tobacco; cigarette smoke also contains lower concentrations of solid particulate matter. All three types of smoking contain nicotine, which is addictive and has harmful biological effects. #p#分页标题#e#
 

Toxic compounds in the three types of smoking

Professor Münzel stated: "The overlap of these different toxic compounds may be key to understanding the harmful effects of smoking on health, which requires further research in the future."

The researchers also observed the effects of smoking on COVID-19 infection. In the article, they wrote: "As outlined by the World Health Organization, smoking and hookah may exacerbate COVID-19 symptoms, including more severe consequences such as requiring intensive care and mechanical ventilation."

They concluded: "Undoubtedly, quitting smoking remains the most effective way to prevent cardiovascular and respiratory diseases caused by smoking. Given the COVID-19 pandemic, this is likely even more important, as the use of tobacco products may increase the risk of smokers developing COVID-19-related cardiovascular and other serious complications."

Professor Münzel stated: "The WHO warns that although e-cigarettes seem to be less harmful than cigarettes, increasing evidence suggests that e-cigarettes may also have side effects on the lungs, heart, and blood vessels, and using e-cigarettes may increase the risk of COVID-19 infection."