Understanding the Dangers of Smoking: Cigarettes, Vapes, and Hookahs
Smoking, in all its forms, is a leading cause of non-communicable diseases globally, significantly contributing to cardiovascular disease (CVD) and lung disease. Among these, cigarettes remain the most traditional, while vapes have gained popularity, especially among younger individuals. However, the debate on the relative harm of vapes compared to cigarettes continues. German researchers have recently conducted a comprehensive comparison of the harms of cigarettes, vapes, and hookahs on human health and cardiovascular disease for the first time.

The Study and Its Findings of Cigs, Vapes and Hookahs’
The research, led by Professor Thomas Münzel from the University of Mainz Medical Center and published in the European Heart Journal, explored the effects of these smoking methods on vascular endothelial cells and human health. The study summarized the existing evidence of harmful chemicals produced by smoking and the mechanisms by which they affect the body. It also compared the effects of cigarettes, vapes, and hookahs on diseases such as stroke, heart disease, and lung cancer.
Comparing the Harms
Previous studies have indicated that smoking can lead to endothelial dysfunction and vascular damage. Long-term exposure to tobacco smoke can impair acetylcholine-dependent vasodilation and coronary blood flow, which is associated with elevated plasma cholesterol levels. The research team found that cigarettes are generally more harmful than vapes, but there is a need for more data on the effects of waterpipe and vape use on endothelial dysfunction. Importantly, they emphasized that waterpipes should not be considered a healthy alternative to cigarettes.
Risks of Chronic Obstructive Pulmonary Disease (COPD) and Lung Cancer
The researchers reviewed evidence showing that compared to non-smokers, cigarettes increase the risk of COPD by 704%, waterpipes by 218%, and vapes by 194%. Similarly, cigarettes and waterpipes increase the risk of lung cancer significantly. The data on vapes is not yet sufficient to draw reliable conclusions.
Arteriosclerosis and Smoking
Arteriosclerosis, a key indicator of the risk of heart disease and stroke, was also studied. Compared to non-smokers, cigarettes increase the risk by 10%, hookah by 9%, and vapes by 7%.
The Role of Oxidative Stress and Free Radicals
Professor Münzel highlighted the adverse effects of these smoking methods on endothelial dysfunction and their relationship with oxidative stress. Smoking increases the levels of oxygen free radicals in vascular tissue, which decompose nitric oxide released by endothelial cells. Nitric oxide is crucial for blood vessel dilation, preventing inflammation, and arterial blockage.

Toxic Compounds in Smoke
The main toxic chemicals in vape vapor include formaldehyde and acrolein, along with trace amounts of transition metals and volatile organic compounds (VOCs), which can damage cells. Cigarettes and water pipes contain more complex harmful chemicals, including solid particles from burning charcoal in waterpipes and low concentrations of solid particles in cigarette smoke. All three types of smoke contain nicotine, which has addictive and harmful biological effects.
Smoking and COVID-19
The researchers also observed the effect of smoking on COVID-19 infection, noting that cigarettes and waterpipes may worsen COVID-19 symptoms and increase the risk of severe complications. They concluded that smoking cessation is the most effective way to prevent smoking-caused cardiovascular and respiratory diseases, which is even more critical during the COVID-19 pandemic due to the potential increased risk associated with tobacco product use.
The World Health Organization warns that while vapes may appear less harmful than cigarettes, there is growing evidence of their side effects on the lungs, heart, and blood vessels, and their potential to increase the risk of COVID-19 infection. It is clear that understanding and addressing the smoking habits, including cigarettes, vapes, and hookahs, is crucial for improving human health and reducing the burden of non-communicable diseases.