The Potential Hazards of E-Cigarette and Dual Use: a Cochrane Systematic Review and Secondary Analysis

Dec.01.2022
The Potential Hazards of E-Cigarette and Dual Use: a Cochrane Systematic Review and Secondary Analysis
A study on Cochrane's systematic review found that switching from smoking to e-cigarettes significantly reduces potential harm biomarkers. However, a separate study found that using both traditional and e-cigarettes has the same harmful effect on the heart as smoking alone.

Title: Biomarkers of potential harm from switching from tobacco smoking to e-cigarette use, dual use or cessation: a Cochrane systematic review and meta-analysis of secondary analysis of data from randomized controlled trials of electronic cigarettes for smoking cessation. In this study, researchers conducted a secondary analysis of data from randomized controlled trials of electronic cigarettes for smoking cessation in Greece, Italy, Poland, the United Kingdom, and the United States. The conclusion drawn was that switching from tobacco smoking to e-cigarette use significantly lowered potential harmful biomarkers.


At the same time, according to a recent study published in the American Heart Association journal "Circulation," using both traditional cigarettes and e-cigarettes poses the same risk to the heart as smoking alone.


A study titled "Association Between Patterns of Cigarette and E-Cigarette Use and Inflammatory and Oxidative Stress Biomarker Levels in U.S. Adults: A Population Assessment of Tobacco and Health Study" analyzed more than 7,100 U.S. adults aged 18 and over to explore the connection between smoking, vaping, and heart health.


Researchers used data from the Population Assessment of Tobacco and Health (PATH) study to search for biomarkers of inflammation and oxidative stress, as these biomarkers are known to indicate predictive factors for heart disease and cardiovascular events, such as heart attacks and heart failure.


After analyzing five biomarkers of inflammation and oxidative stress, participants were divided into four groups: exclusive smokers, exclusive e-cigarette users, dual users, and non-users of e-cigarettes. Researchers listed the following findings:


Participants who only use electronic cigarettes showed similar levels of inflammation and oxidative stress as those who do not use electronic cigarettes or smoke at all. However, compared to participants who do not use cigarettes or electronic cigarettes, those who smoke exclusively or use both cigarettes and electronic cigarettes had higher levels of all evaluated biomarkers. Participants who only use electronic cigarettes had significantly lower levels of nearly all inflammation and oxidative stress biomarkers compared to those who only smoke. However, participants who use both cigarettes and electronic cigarettes had biomarker levels similar to those who exclusively smoke. 2FIRSTS will continue to report on this issue, with updates available on the "2FIRSTSAPP". Scan the QR code below to download the app.



Disclaimer

This article is provided solely for professional research, industry discussion, and informational purposes. Any references to brands, companies, products, technologies, or policies are made for factual reporting and analytical purposes only, and do not constitute endorsement, recommendation, promotion, or advertising by 2Firsts.

Nicotine-containing products, including but not limited to cigarettes, e-cigarettes, heated tobacco products, and nicotine pouches, carry significant health risks. Readers are responsible for complying with all applicable laws and regulations in their respective jurisdictions, including age restrictions and access limitations.

The information contained in this article should not be regarded as investment, legal, medical, regulatory, or commercial advice. While 2Firsts strives to ensure the accuracy and reliability of its content, it does not assume liability for any direct or indirect loss arising from errors, omissions, inaccuracies, or reliance on the information contained herein.

This article is not intended for individuals below the legal age for accessing tobacco or nicotine-related information in their jurisdiction.

 

Copyright Notice

This article is either original content produced by 2Firsts or content reproduced, translated, summarized, or adapted from third-party sources with attribution where applicable. The intellectual property rights of the original content remain with 2Firsts or the respective original rights holders.

No individual or organization may copy, reproduce, distribute, republish, modify, translate, or otherwise use this content without prior authorization. Any unauthorized use may result in legal action.

For copyright-related inquiries, corrections, or removal requests, please contact: info@2firsts.com.

 

AI-Assisted Translation and Editing Notice

Portions of this article may have been translated, edited, or reviewed with the assistance of artificial intelligence tools to improve efficiency and readability. Due to the limitations of AI-assisted translation and editing, discrepancies, omissions, or inaccuracies may exist when compared with the original source.

Where applicable, readers are advised to refer to the original source for the most complete and accurate information. If you identify any errors or believe that any content infringes upon your rights, please contact us at info@2firsts.com, and we will review and address the matter promptly.

As Regulators Focus on Nicotine Pouch Child Safety, Safeguard Pursues an External Packaging Route
As Regulators Focus on Nicotine Pouch Child Safety, Safeguard Pursues an External Packaging Route
As regulators pay closer attention to child safety in nicotine pouches, manufacturers face a practical challenge: how to strengthen child-resistant packaging without unnecessarily reworking products, production lines and regulatory submissions already in place. In a written interview with 2Firsts, Chemular detailed Safeguard’s external packaging approach, its customer-specific testing requirements and possible PMTA pathways. The model remains early-stage, but it offers a new way to think about an increasingly important regulatory and manufacturing issue.
Industry Insight
Sep.19
FDA Unifies Tobacco Registration and Product Listing Form Across Product Categories
FDA Unifies Tobacco Registration and Product Listing Form Across Product Categories
The U.S. FDA has consolidated two tobacco establishment registration and product listing forms into a redesigned Form FDA 3741 covering all regulated product categories, including e-cigarettes, heated tobacco products and nicotine pouches. The current requirements remain limited to domestic establishments. Separately, the FDA has proposed extending registration and product listing requirements to foreign manufacturers, signaling greater regulatory attention to manufacturing entities and product-level information across the tobacco and nicotine supply chain.
FDA
Sep.30
Gallery | InterTabac 2026 Opens as VAPORESSO, SKE, GREENTANK, GEEK BAR and Other Brands Take the Floor
Gallery | InterTabac 2026 Opens as VAPORESSO, SKE, GREENTANK, GEEK BAR and Other Brands Take the Floor
InterTabac 2026 opened in Dortmund, Germany, on September 15 alongside NUBIZ and InterSupply. According to the latest figures released by the organizer, the three trade shows bring together around 750 exhibitors from 64 countries. On site, 2Firsts observed vaping and related brands including VAPORESSO, DOJO, SKE, GREENTANK, GEEK BAR, HQD and ELUX.
Special Report
Sep.15
FDA Revises Import Alert 98-07 Rules, Bringing May Enforcement Priorities Into Unauthorized ENDS Detentions
FDA Revises Import Alert 98-07 Rules, Bringing May Enforcement Priorities Into Unauthorized ENDS Detentions
The U.S. Food and Drug Administration has revised the rules under Import Alert 98-07 to incorporate its May 2026 enforcement-priority policy for certain electronic nicotine delivery systems marketed without premarket authorization. The alert continues to allow detention without physical examination, or DWPE, for ENDS lacking required marketing authorization, while directing field divisions to apply the May risk-based framework. When necessary, detention or refusal decisions must also undergo review by the FDA's Center for Tobacco Products. Products including PACHA and Vuse Pro have already emerged as industry examples of the May policy, although enforcement discretion does not constitute FDA marketing authorization.
News
Sep.28 by 2Firsts Perspectives
F1 Faces Renewed Pressure Over Tobacco and Nicotine Sponsorships as 67 Groups Target ZYN and VELO Ahead of Madrid Race
F1 Faces Renewed Pressure Over Tobacco and Nicotine Sponsorships as 67 Groups Target ZYN and VELO Ahead of Madrid Race
Ahead of the Formula 1 race in Madrid, 67 Spanish and international public-health, medical and consumer organizations have sent an open letter to F1 President and CEO Stefano Domenicali calling for an end to sponsorships linked to the tobacco and nicotine industry, including nicotine pouches, vaping products and heated tobacco. The letter focuses on Philip Morris International’s ZYN partnership with Ferrari and British American Tobacco’s long-running partnership with McLaren and exposure for VELO. The campaign follows a March letter in which more than 160 organizations worldwide made a similar request to Formula 1.
Sep.10
Arizona Turns to a 50% Retail Vape Tax as Tobacco Tax Revenue Falls 47% From 2008
Arizona Turns to a 50% Retail Vape Tax as Tobacco Tax Revenue Falls 47% From 2008
Arizona's First Things First is pushing for an excise tax equal to 50% of the retail price of vaping products, estimating that the measure could generate about $100 million annually. The agency says its tobacco-tax revenue has fallen 47% from 2008 levels. Arizona has attempted to broaden its nicotine tax base in each of the past two years: a 2025 bill proposed a 50% wholesale-price tax, while a 2026 measure shifted to a 50% retail-price tax covering alternative nicotine products and vapor products. Separately, the state enacted HB 4001 this year to establish a new licensing and sales framework for alternative nicotine products.
Sep.21