Are electronic cigarettes any safer for your PVD patient than traditional cigarettes? I would tend to say "no," but that is based on a host of prejudices I have against the habit. But I decided to see what the literature says about this one. blu_electronic_cigarette

This same up when I encountered an amputee with an e-cig and struck up a conversation. He had almost completely stopped using regular tobacco products. I later spoke with his physician and he backed the patient up. The doctor did, indeed, promote the use of the e-cig for his patients.

I haven't yet found any literature addressing PVD and e-cigs but I did find a study that was presented in 2012 at the European Society of Cardiology that reported that the electronic cigarettes do not damage the heart. That is a big claim. If you aren't familiar with them, they consist of a rechargable battery, a replaceable cartridge that holds liquid, a heating element that evaporates that liquid (producing the vapor that appears to be smoke), The power that they pack is the nicotine in the liquid, along with some other carrier agents and flavorings and preservatives.

The study at the ESCd was done by examining myocardial function using echocardiography, blood pressure and heart rate. Researchers noted that smoking one traditional cigarette led to "significant acute myocardial dysfunction" but electronic cigarettes had no acute adverse effects. Tobacco produced important hemodynamic consequences, increases in systolic and diastolic pressures and heart rate. The e-cigarette produced only a slight elevation in diastolic pressure. They noted that the nicotine in the e-cig was absorbed at a lower rate than the traditional.

That's all very interesting and time, and studies, will show more. Some healthcare providers have even said that the e-cig may help the poor to cut down on tobacco use. Why? The cost.

Currently, and probably ONLY currently, the states haven't come up with a formula for taxing them but they will. In California, a carton of 20 packs of cigarettes, name brand, can cost over $50. The number of cartridges equalling 20 packs can cost between $5 and $10. The reason? No big tobacco tax.

In America, cig taxes range from a high in NY at $4.35 per package to a measly 30 cents in tobacco producing Virginia. Most are in the $1-3 range. That's a lot of tax dollars lost and they could be going toward helping smokers with heart, I mean, well, what if the rate of heart disease goes down with e-cigs. Hmm, a very tangled situation indeed.

State cigarette tax rates from

The following table lists American state and territory tax rates (as of August 1, 2013):[23][25]

Taxes on the purchase of packs of cigarettes in each state
States are shaded on a continuous color scale where
Less Than $2 Excise Tax Per Pack
$2 Excise Tax Per Pack
$4 Excise Tax Per Pack

Excise Tax Per Pack (USD)State/Territory
1.68New Hampshire
2.70New Jersey
1.66New Mexico
4.35[27]New York
0.45North Carolina
0.44North Dakota
1.18 (1.31 effective 1/1/14)Oregon
3.50Rhode Island
0.57South Carolina
1.53South Dakota
0.55West Virginia
2.50District of Columbia
1.75Northern Marianas Islands
2.23Puerto Rico
2.50American Samoa
1.78U.S. Virgin Islands




Some cities add onto this amount per pack, including NYC and Anchorage Alaska among others.

  • Comments (2)
  • I wondered the same thing, David, and I went searching for an answer. Apparently they are catching on for a variety of reasons - more social accessibility, lower cost, and pleasure. It isn't the tar or byproducts of the cigarette that grabs people. It is the nicotine and in these e cigs that is available in varying strengths. It is sort of like mainlining the nicotine.

    I wondered why a doctor was trying to get his smoking patients to switch to these and I am starting to get it now. If I could have the results of any research protocol, I would ask for a longitudinal prospective study of the e cigarettes versus traditional tobacco and see what damage is done by both after a length of time. It will be a long time for that to happen but in the interim I was surprised to see this cardiac study. An interesting little measurement with limitations but an intriguing first start.

    I am beginning to see why this MD is advising his chronic smokers to make the switch. There is something there.

  • The circulatory findings of whole tobacco v. just nicotine is interesting. It recalls the statements of herbal medicinalists who state 'you can't separate one item from the mix' when discussing failures of single ingrediant trials. Maybe nicotine on its own is not the culprit. Maybe you need all the many other products created when smoking.
    In which case e-cigs wont last. They wont have the same kick.
    Dave Gottlieb,DPM personal views only