“As Unfit as Smokers” Alarmist Headlines Once Again Ignore the Wider Evidence on Vaping

A new narrative review published in Cureus examined evidence on e-cigarettes, heated tobacco products, and oral nicotine products. In line with previous studies, it concluded that exclusive use of smoke-free alternatives generally produces much lower exposure to chemicals implicated in cardiovascular disease than combustible smoking. The findings reinforce a central principle of tobacco harm reduction: nicotine is addictive and not harmless, but inhaling the products of combustion is responsible for most smoking-related disease.

Cigarette smoke contains carbon monoxide, acrolein, benzene and hydrogen cyanide, among many other toxic substances. These can damage blood vessels, promote inflammation and oxidative stress, increase platelet activation and contribute to blood clots and fatty deposits in arteries.

Because vaping heats a liquid instead of burning tobacco, it avoids carbon monoxide, tar and many other combustion-related toxicants. Clinical studies reviewed by the authors generally recorded substantial reductions in biomarkers of toxicant exposure after smokers switched to vaping. In some cases, levels among exclusive vapers approached those found in people who had stopped using tobacco and nicotine entirely.

Researchers also observed favourable changes in several indicators of potential cardiovascular harm, including inflammation, oxidative stress, platelet activity and HDL cholesterol. One 24-week trial involving smokers who changed to a pod-based vaping product recorded improvements in five cardiovascular-related markers, including white blood cell counts and indicators of platelet activation and blood-vessel damage.

Other studies found that blood pressure and heart rate dropped when cigarettes were either partially or fully replaced. The UK-based VESUVIUS trial showed that smokers who made the switch to e-cigarettes saw improvements in blood-vessel function within just one month, with those who switched completely showing even better results. And while these intermediate markers don’t really indicate how many heart attacks vaping could potentially prevent in the long run, the trend is clear: reducing toxic exposure by eliminating combustion leads to significant benefits.

The most critical takeaway from the review focuses on dual use. Individuals who quit smoking and used only e-cigarettes typically had more favourable cardiovascular biomarkers compared to those who continued smoking. On the flip side, people who both smoked and vaped often exhibited risk profiles that were quite similar to exclusive smokers.

This is biologically plausible because cardiovascular risk does not fall in direct proportion to the number of cigarettes smoked. Even low-level smoking carries a surprisingly large share of the coronary heart disease and stroke risk associated with heavier consumption.

Dual use can be a transitional stage while a smoker becomes accustomed to vaping, but it should not become the final objective. Services and retailers supporting smokers should encourage them to replace cigarettes completely and keep the period of dual use as short as practicable.

This evidence provides essential context for a Manchester Metropolitan University study that generated headlines suggesting young vapers were “as unfit as smokers.” Published in ERJ Open Research, the study examined 75 adults aged 18–30: 25 exclusive vapers who had never smoked, 25 smokers who did not vape and 25 never-users. Both nicotine-using groups displayed approximately 15% lower peak exercise capacity than never-users, alongside earlier lactate accumulation, greater breathlessness and differences in vascular function and inflammation.

The findings are relevant for never-smokers, who receive no health benefit from taking up vaping. But the cross-sectional study could not establish that vaping caused the measured differences because participants were not tested before they began using nicotine. The sample was also small, while differences in sleep, diet, previous illness and exercise intensity could not be eliminated completely.

Most importantly, similar outcomes in selected fitness tests do not demonstrate equivalent lifetime risks of cancer, COPD, cardiovascular disease or premature death. The study asked whether vaping is risk-free for young never-smokers—not whether smokers reduce their risk by switching. Both messages can therefore be true: vaping may have measurable physiological effects in never-smokers, while still being substantially less harmful than continued smoking.

Accurate communication matters because exaggerating vaping risks can influence behaviour. The 2026 Action on Smoking and Health survey, based on a weighted YouGov sample of 13,259 British adults, found that 19% of respondents who had attempted to stop vaping and named a quitting method reported using cigarettes. Nicotine-replacement therapy was the most common method, at 31%.

Cigarette use was reported by 33% of those who believed vaping was more harmful than smoking, compared with 20% who considered the risks equal and 14% who correctly understood that vaping is less harmful. The survey cannot prove that misperceptions caused smoking, and some respondents may have been former or dual users. Nevertheless, the pattern is troubling.

ASH also found that 54% of British adults believed vaping was at least as harmful as smoking. Among smokers who had never vaped, that figure reached 61%. Such misconceptions could deter switching or encourage former smokers to abandon vaping before they are ready, increasing their risk of relapse.

A recent Cochrane living review looking at 104 studies with 30,366 adult smokers found strong evidence that nicotine e-cigarettes help more people quit smoking compared to traditional nicotine-replacement therapies. For every 100 individuals trying to quit, about eight to eleven managed to succeed with vaping, while roughly six did so with patches or gum. Cochrane

Similarly, a 2024 randomised trial involving 1,246 adults found that providing free vapes alongside standard cessation counselling led to higher verified smoking-abstinence rates than counselling by itself. The rates of serious adverse events were similar throughout the six-month trial, though longer follow-up is needed.

Thus, the evidence backs up a balanced message regarding risks. Young people and never-smokers should avoid vaping altogether. Adult smokers who are struggling to quit through other methods might benefit from switching completely, whereas those who have quit smoking should only stop vaping when it’s unlikely to trigger a relapse.

Vaping isn’t without risks, but it’s certainly nowhere as close to being as harmful as smoking either. Public health policies that blur this line could turn a valid concern about potential vaping harm into a much greater risk of returning to combustible cigarettes.

https://www.vapingpost.com/2026/01/30/the-cost-of-bad-science-how-flawed-studies-and-anti-nicotine-bias-are-shaping-european-tobacco-policy/