How You Quit Smoking Matters

When individuals attempt to quit smoking, harm reduction measures replace nicotine in an alternative form of administration are often the first think they turn to. Readily available options include nicotine gum, patches, and e-cigarettes or vape pens all of which administer as controlled dose of the addictive component of tobacco.

The rationale behind nicotine replacement is one of harm reduction. Smoking tobacco carries a known risk of lung cancer and heart disease, and while replacement does not break the cycle of addiction, it does lower the risk of harm caused by cigarette smoke to both smokers and those exposed to second-hand smoke such as family members.

New data is now questioning whether one form of nicotine replacement – the e-cigarette or vape pen – is acting appropriately as harm reduction. E-cigarette toxicity, has been significantly studied, especially with regard to lung inflammation and injury.1 Despite known risks, use is still relatively common, and surveys indicate that many people use cigarettes and e-cigarettes together, which may defeat the point.

The latest data, published in the journal Circulation, indicates that there is no statistical difference in the number of heart attacks, heart failure or strokes among people who combine use of cigarettes and e-cigarettes, when compared to those who only smoke cigarettes.2 Reduction in cardiac risk was seen in those who only used e-cigarettes, but the number reporting exclusive use was too small to draw an accurate conclusion. Overall, the researchers advised against use of e-cigarettes as an alternative to cigarettes.

Nicotine addiction remains the most common addiction in the world. In the US alone, approximately 14% of the population (34.1 million Americans) currently smoke cigarettes. Nearly half a million deaths are attributed to cigarette smoking every year.



  1. Gordon T, Karey E, Rebuli ME, Escobar YNH, Jaspers I, Chen LC. E-Cigarette Toxicology. Annu Rev Pharmacol Toxicol. 2022;62(1):301-322. doi:10.1146/annurev-pharmtox-042921-084202
  2. Berlowitz JB, Xie W, Harlow AF, et al. E-Cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study (2013–2019). Circulation. 2022;145(20):1557-1559. doi:10.1161/CIRCULATIONAHA.121.057369