Stanton Glantz Strikes Again… With Another Innacurate Heart Study

To the relief of many in the THR scientific community, in 2020 Prof. Stanton A Glantz, "retired" from the University of California-San Francisco (UCSF) without warning and/or explanation. Sadly, this has not stopped him from publishing more of his incomplete and biased material.

A recent study by the infamous anti-safer nicotine alternatives crusader Professor Stanton Glantz, claims that vaping poses a similar risk for cardiovascular disease, stroke, and metabolic dysfunction, as smoking. Published in the New England Journal of Medicine Evidence, the study conducted a systematic review and meta-analysis of publications comparing odds’ ratios of diseases between vapers and smokers.

Renowned cardiologist and reseacher in the fields of echocardiography, smoking and tobacco harm reduction (THR) research, Konstantinos Farsalinos, MD, MPH, responded to the “findings.” He highlighted that to effectively address the question of disease risk from e-cigarette use, one would require studies involving vapers who had never smoked, and study their disease risk compared to that of smokers. This would rule out the effects of current or former smoking: a fact that any experienced researcher would take into consideration.

Ideally, such studies should span many years to observe the development of cardiovascular diseases, examining individuals using e-cigarettes for an extended period. Moreover, they should analyze longitudinal or cross-sectional studies with data on the duration and frequency of e-cigarette use, past and current smoking status, and the temporal association between e-cigarette use initiation and disease development.

In contrast, Glantz’s meta-analysis included 107 studies reporting 124 odds ratios, with a majority (97 out of 124) derived from cross-sectional studies, which lack information on the temporality of events. The study design fails to provide insights into the duration and frequency of vaping, the timing of disease occurrence relative to e-cigarette initiation, or whether dual users engaged in both smoking and vaping were examined thoroughly.

Farsalinos highlighted that the current study’s methodology is reminiscent of another  metanalysis by Glantz, which concluded that vaping prevents smoking cessation, by including participants who were failures at baseline and people who were not regular vapers but only experimenting with the products. “Today we know not only that e-cigarettes are effective in smoking cessation but that it is currently THE BEST smoking cessation aid available, equally effective to varenicline which, however, has been withdrawn to the market,” explained Farsalinos.

In an email communication with Dr. Farsalinos, a seasoned and meticulous researcher himself, Vaping Post brought up another baffling factor staring us all in the face: How do supposedly reliable scientific journals keep publishing these inaccurate studies? How do their peer reviews miss these “errors” and biases? He replied that he is as astonished as the rest of us. “I literally have no idea how they do it,” he added.

The difference in the effects of cigarettes and non-combustible nicotine products on heart health is scientifically undeniable
Meanwhile countless studies have indicated the stark contrast on the effects of heart health between smoking and non-combustibe tobacco/nicotine products. A 2022 study by a research team from Herlev and Gentofte Hospital in Copenhagen found that smoking has a negative impact on the structure and function of the heart and that quitting can help reverse this damage. The research team emphasized that the damage observed by smoking was worse than previously thought.

Holt and her team evaluated data from over 3,800 participants, aged between 20 and 93 who did not have a history of heart disease. They collected information about the participants’ tobacco use behaviour via questionnaire, after which they conducted an echocardiogram or ultrasound of the heart.

While, another study published in the journal Nicotine and Tobacco Research, indicated the relative safety of smokeless tobacco products, and how switching to the products from combustible cigarettes was associated with lower cardiovascular disease risk in smokers.

The study, “Associations of Smokeless Tobacco Use With Cardiovascular Disease Risk: Insights From the Population Assessment of Tobacco and Health Study” analyzed data from a nationally representative group of 4,347 adults who provided urine and blood samples in 2013–14 as part of the Population Assessment of Tobacco and Health (PATH) Study. Among this group, 3,034 participants used cigarettes exclusively, 338 used only smokeless tobacco, and 975 had never used any tobacco product.

Similar nicotine levels but lower disease biomarkers
The research team analysed the participants’ samples for biomarkers of tobacco exposure, inflammation and oxidative stress, which are predictors of cardiovascular disease risk, in each of the three subgroups. The compiled data indicated that despite similar nicotine levels, smokeless tobacco users displayed significantly lower biomarkers of disease.

“Our findings show that despite having higher levels of nicotine, exclusive smokeless tobacco users had significantly lower concentrations of inflammation and oxidative stress biomarkers than cigarette smokers. Levels of these biomarkers among smokeless tobacco users were similar to those of ‘never’ smokers,” said lead study author Mary Rezk-Hanna, who is an assistant professor at UCLA School of Nursing.