抽烟有害健康，但戒烟的痛苦，让许多人会选择使用一些替代品来帮助戒烟。人们曾经认为电子烟是烟草香烟的安全替代品。如今，研究人员称，吸电子烟可能导致患心血管疾病。
关键词：科普、译文、电子烟、疾病风险
E-cigarettes are safer than cigarettes butthat doesn’t mean they’re harmless.
电子烟比香烟更安全，但这并不意味着它们是无害的。
Several recent observational studies havefound a link between regular vaping and an increased risk of heart attack,stroke, and coronary artery disease. |Getty Images
最近的几项观察性研究发现，经常吸电子烟与心脏病、中风和冠状动脉疾病的风险增加之间存在联系。|盖蒂图片
When e-cigarettes first appeared on store shelves a few years back, they were marketed as a sleek, discreet technology that could help adult smokers kick a potentially deadly habit.
几年前，当电子香烟首次出现在商店货架上时，它们被作为一种时尚的技术推向市场，可以帮助成年吸烟者戒掉一个潜在的致命习惯。
Flash forward to 2018, the year the Juul vape device took over three-quarters of the US e-cigarette market. Instead of catering to adult smokers, the e-cigarette industry appeared to be overwhelmingly targeting nonsmoking youth.
转眼到了2018年，Juul vape占据了美国电子烟市场四分之三的份额。电子烟行业似乎主要针对不吸烟的年轻人，而不是迎合成年吸烟者。
Maciej Goniewicz, one of the leading e-cigarette researchers based at Roswell Park Comprehensive Cancer Center in Buffalo, has watched the shift unfold up close: The volunteers who come forward for his e-cigarette studies seem to be getting younger.
布法罗的罗斯威尔帕克综合癌症中心的首席电子烟研究人员之一Maciej Goniewicz近距离观察到了这一转变：他的那些电子烟研究的志愿者似乎越来越年轻了。
“[These are] people who were breathing pure air for a long time — and have never smoked tobacco cigarettes — who now have started using e-cigarettes,” Goniewicz said.
Goniewicz说：“这些人长期以来一直呼吸着纯净的空气，从来没有吸过烟草烟，但现在他们开始吸电子烟了。”
He and other researchers around the world are now scrambling to figure out what impact this new habit might have on developing bodies and brains in the long term. And they’re finding that e-cigarettes may be more dangerous than we’ve appreciated, especially for hearts and lungs. There’s also a growing body of research suggesting that vaping can lead to smoking.
他和世界各地的其他研究人员现在正忙于弄清楚，从长远来看，这种新习惯可能会对身体和大脑的发育产生什么影响。而且他们发现电子烟可能比我们想象的更危险，尤其是对心脏和肺部。越来越多的研究表明，电子烟会导致吸烟。
But before we dive into the latest health concerns, a couple notes of caution. The new evidence doesn’t mean cigarettes are safer than e-cigarettes. In fact, medical experts agree that vaping is far better for health than smoking, one of the deadliest habits known to man. (And that message about relative risk appears to be getting lost, as more and more people erroneously believe e-cigarettes are as or more dangerous than tobacco.)
但在我们深入研究最新的健康问题之前，有几点需要注意。新的证据并不意味着香烟比电子烟更安全。事实上，医学专家一致认为，电子烟对健康的好处远远超过香烟，吸烟是人类已知的最致命的习惯之一。（随着越来越多的人错误地认为电子烟和烟草一样或更危险，关于相对风险的信息似乎正在消失。）
What’s more, since people haven’t been vaping for very long, the science on its health effects is still preliminary — and far from conclusive. It may take decades for any diseases possibly caused by e-cigarettes to fully surface, particularly in the young, healthy people now using them.
更重要的是，由于人们吸电子烟的时间不长，有关电子烟对健康影响的科学研究还处于初级阶段，尚未得出定论。任何可能由电子烟引起的疾病都可能需要几十年的时间才能完全显现出来，尤其对于现在正在使用电子烟的健康年轻人。
There’s also the problem of making generalizations about e-cigs: There are hundreds of devices on the market, and each one delivers different levels of nicotine (or no nicotine at all) and a slightly different cocktail of chemicals.
对电子烟进行归纳也存在一个问题：市场上有数百种电子烟，每一种电子烟都含有不同程度的尼古丁(或者根本不含尼古丁)，以及略微不同的混合化学物质。
With these caveats in mind, I asked researchers to share what worries them most. Here’s what they told me.
考虑到这些警告，我请研究人员分享了他们最担心的事情。以下他们告诉我的。
The nicotine in e-cigarettes may stress the cardiovascular system
电子烟中的尼古丁可能会对心血管系统造成压力
When you turn on an e-cigarette, you’re heating a liquid that contains flavors and other chemicals, and often, nicotine.
当你打开电子烟时，你加热的是一种含有香料和其他化学物质的液体，通常还含有尼古丁。
Some devices, in particular Juul, deliver spectacularly high doses of nicotine. (Juul says one of its e-liquid pods is equal to a pack of cigarettes in terms of nicotine.)
一些设备，特别是Juul，提供了极高剂量的尼古丁。（Juul的一个电子液体胶囊的尼古丁含量相当于一包香烟。）
“Nicotine [in e-cigarettes] does the same thing as [combustible] cigarettes,” said Neal Benowitz, a professor of medicine at the University of California San Francisco who’s been studying the link between e-cigarettes and heart health. It can increase the adrenaline circulating in our bodies, and activate the sympathetic nervous system (our “fight or flight” response), raising blood pressure, speeding up the heart rate, and causing the arteries — the vessels that carry blood — to narrow.
“（电子香烟中的）尼古丁与（可燃）香烟的作用相同，”加州大学旧金山分校医学教授Neal Benowitz说，他一直在研究电子香烟与心脏健康之间的关系。它会增加我们体内循环的肾上腺素，并激活交感神经系统(我们的“战斗或逃跑”反应)，升高血压，加速心率，并导致动脉 - 运送血液的血管 - 收缩。
In January of last year, the National Academies of Sciences, Engineering, and Medicine in its assessment of the evidence on the health impact of vaping determined that there was “insufficient” evidence that e-cigarette use leads to long-term changes in heart rate and blood pressure.
去年1月，美国国家科学、工程和医学研究院在评估电子烟对健康影响的证据时认定，没有“足够”的证据表明电子烟的使用会导致心率和血压的长期变化。
But Goniewicz told Vox that’s rapidly changing. The impact of e-cigarettes on the body’s cardiovascular system is an emerging area of research — with more studies piling up to suggest vaping could in fact be bad for the heart.
但是Goniewicz告诉Vox，这种情况正在迅速发生变化。电子烟对人体心血管系统的影响是一个新兴的研究领域，越来越多的研究表明，电子烟实际上可能对心脏有害。
In a review of the literature, for the Nature Reviews Cardiology journal, Benowitz and his co-authors made the case that while we don’t yet know what that means for long-term health outcomes, it’s possible nicotine in e-cigarettes will contribute to cardiovascular events, “particularly in people with underlying cardiovascular disease.”
在为《自然评论心脏病学》杂志撰写的一篇文献综述中，Benowitz和他的合著者提出，虽然我们还不知道这对长期健康意味着什么，电子烟中的尼古丁可能会导致心血管疾病，“尤其是潜在心血管疾病患者”。
Several recent observational studies have found a link between regular vaping and an increased risk of heart attacks, strokes, and coronary artery disease. The studies don’t prove e-cigarettes cause these conditions, but given the known cardiovascular effects of nicotine, there’s likely a lot more to learn about vaping and its effect on these diseases.
最近的几项观察性研究发现，经常吸电子烟与心脏病、中风和冠状动脉疾病的风险增加之间存在关联。这些研究并没有证明电子烟会导致这些症状，但鉴于已知的尼古丁对心血管的影响，关于电子烟及其对这些疾病的影响还需进一步了解。
The microscopic particles e-cigarettes emit have been linked to heart attacks, high blood pressure, and coronary artery disease
电子烟所释放的微粒与心脏病、高血压和冠状动脉疾病有关
Even when vapor is nicotine-free, it may carry other heart health risks. The heating element in e-cigarettes emits tiny particles, sometimes including metals, and these can lodge themselves deep into the lungs and get absorbed into the body’s circulatory system. “That’s where we see the potential cardiovascular toxicity,” Goniewicz said.
即使蒸汽中不含尼古丁，它也可能带来其他的心脏健康风险。电子烟中的加热元件会释放出微小的颗粒，有时包括金属颗粒，这些颗粒会深入肺部，被人体的循环系统吸收。“这就是我们看到的对心血管的潜在毒性，”Goniewicz说。
Recent studies have shown that puffing on e-cigarettes increases concentration of these microscopic pollutants — in particular, PM2.5 and ultrafine particles — in indoor environments.
最近的研究表明，吸电子烟会增加室内环境中这些微小污染物的浓度，尤其是PM2.5和超细颗粒物。
Researchers don’t yet know what risks e-cigarette aerosol particles carry, but these tiny particles have been studied extensively in the context of air pollution and tobacco smoking. In those studies, researchers have linked exposure to small particles with a range of bad cardiovascular outcomes — including heart attacks, high blood pressure, and coronary artery disease.
研究人员还不知道电子烟的气溶胶颗粒会带来什么风险，但在空气污染和吸烟的背景下，人们对这些微小颗粒进行了广泛的研究。在这些研究中，研究人员将接触小颗粒与一系列不良的心血管后果联系起来 - 包括心脏病发作、高血压和冠状动脉疾病。
The thinking is that when we’re exposed to large particles — like dust — our bodies mount a defense against them. Namely, we cough, kicking these foreign pollutants out of our respiratory tract. But with fine particulate matter, that defense mechanism doesn’t kick in — and again, these micro contaminants can seep into our lungs and cardiovascular system.
他们的想法是，当我们暴露在像灰尘这样的大颗粒中时，我们的身体就会对它们进行防御。也就是说，我们通过咳嗽将这些外来污染物从呼吸道中排出。但是对于细颗粒物，这种防御机制不会发挥作用 - 再说一次，这些微污染物会渗入我们的肺部和心血管系统。
Same goes for other toxic chemicals e-cigarettes produce when they’re heated, such as acetaldehyde, formaldehyde, and acrolein.
电子烟加热时产生的其他有毒化学物质，如乙醛、甲醛和丙烯醛，也会产生同样的效果。
“We already have sufficient evidence from hundreds of studies that link exposure to those chemicals with disease outcomes,” Goniewicz said. “We know that formaldehyde can cause cancer and that acrolein can cause certain cardiovascular diseases.” So there’s no conclusive evidence directly linking this aspect of e-cigarette use to long-term cardiovascular outcomes. But based on these studies, researchers believe such a link is plausible.
Goniewicz说:“我们已经从数百项研究中获得了足够的证据，证明接触这些化学物质会导致疾病。”“我们知道甲醛会致癌，丙烯醛会导致某些心血管疾病。”因此，目前还没有确凿的证据表明使用电子烟与长期心血管疾病的结果有直接联系。但基于这些研究，研究人员认为这种联系似乎是合理的。
E-cigarette vapor may irritate the lungs
电子烟的蒸气可能会刺激肺部
Much of the harm caused by tobacco smoking comes from the combustion process — smoke wears down the cells lining the lungs, damaging them, and making them more penetrable to the irritating, and cancer-causing, chemicals in cigarettes. Since electronic cigarettes don’t burn tobacco, the vapor they produce is thought to be much less harmful than conventional cigarette smoke. But that doesn’t mean vapor is harmless.
吸烟造成的大部分伤害来自燃烧过程 - 烟雾会侵蚀肺部细胞，破坏它们，使它们更容易被香烟中的刺激性和致癌化学物质渗透。由于电子烟不燃烧烟草，因此人们认为电子烟产生的蒸汽比传统香烟的危害要小得多。但这并不意味着蒸汽是无害的。
Breathing vapor into the lungs can irritate them — and that’s been demonstrated in recent research on wheezing. Wheezing — that high-pitched sound caused by narrowed and abnormal airways — is more than just an annoyance: It can be a sign of emphysema, heart failure, and lung cancer.
吸入肺部的蒸汽可能会刺激它们 – 这在最近关于哮喘的研究中得到了证实。哮喘 - 由气道狭窄和异常引起的高音 - 不仅仅是一种烦恼：它可能是肺气肿，心力衰竭和肺癌的征兆。
Researchers recently tracked 28,000 adults to tease out whether e-cigarettes exacerbate wheezing. Some of the people in the study were current vapers who used only e-cigarettes; others were smokers only; still others were dual users (who smoked and vaped); and finally, there were also folks who didn’t smoke or vape at all.
研究人员最近跟踪调查了2.8万名成年人，以弄清电子烟是否会加重哮喘。研究中的一些人目前只吸电子烟；其他一些人只吸香烟；还有一些人是双重使用者（同时吸烟和使用电子烟）；最后，还有一些人根本不抽烟或电子烟。
Compared with that last group — the non-users — the risk of wheezing among the vapers doubled.
与最后一组 - 非使用者 - 相比，使用电子烟的人患哮喘的风险增加了一倍。
When the researchers looked at the study participants’ history of vaping or smoking, they came to even more interesting findings: The risk of wheezing was higher in current vapers who were also ex-smokers than in ex-smokers who did not vape. In other words, it wasn’t just a vaper’s potential history of smoking that was driving the uptick in wheezing among vapers. “Therefore,” the authors concluded, “promoting complete cessation of both smoking and vaping will be beneficial to maximize the risk reduction of wheezing and other related respiratory symptoms.”
当研究人员观察研究参与者的吸电子烟或香烟史时，他们得出了更有趣的发现：戒烟却使用电子烟的人患哮喘的风险高于那些戒烟而没有使用电子烟的人。换句话说，不仅仅是潜在的吸烟史导致了吸电子烟的人中哮喘病的增加。“因此，”作者总结道，“完全戒掉香烟和电子烟将有助于最大限度地降低哮喘和其他相关呼吸道症状的风险。”
Other studies have focused on whether e-cigarette users are more likely to develop chronic obstructive pulmonary disease (COPD), a set of lung complications that make it hard to breathe. Research in mice and human airway cells showed that nicotine-containing e-cigarette vapor seemed to trigger “effects normally associated with the development of COPD.”
其他研究的重点是电子烟使用者是否更容易患上慢性阻塞性肺病(COPD)，这是一种肺部并发症，会导致呼吸困难。对小鼠和人类气道细胞的研究表明，含有尼古丁的电子烟蒸汽似乎会引发“通常与COPD发展相关的影响”。
In preliminary human studies, researchers also found associations between regular vaping and COPD. But again, this human research was observational — not experimental — so it’s not yet clear that vaping caused COPD. (For example, it’s possible the people who have COPD are more likely to use electronic cigarettes, such as ex-smokers seeking a harm-reduction method.)
在初步的人体研究中，研究人员还发现，定期吸电子烟与慢性阻塞性肺病之间存在关联。但同样，这项人类研究是观察性的，而不是实验性的，所以目前还不清楚蒸汽是否会导致慢性阻塞性肺病。（例如，患有COPD的人更有可能使用电子烟，就像戒烟者寻求降低危害的方法。）
Still, Benowitz said, “you don’t want to put stuff in your lungs that could cause lung inflammation. My biggest concern about e-cigarettes is that if you’re not a cigarette smoker, they could potentially aggravate asthma, cause a cough, and increase the risk of respiratory tract infection — like cold, flu and bronchitis.”
尽管如此，Benowitz说，“你不会希望把可能导致肺部炎症的东西放进肺部。我对电子烟最大的担忧是，如果你不吸烟，它们可能会加重哮喘，引起咳嗽，增加呼吸道感染的风险，比如感冒、流感和支气管炎。”
Does vaping help people quit smoking or lead to more smoking?
吸电子烟是帮助人们戒烟还是会带来更多的吸烟?
We still don’t know for sure whether the rise in vaping is leading to fewer adults smoking tobacco. The best available research on the question was published earlier this year in the New England Journal of Medicine. The randomized trial on e-cigarettes showed people who were randomly assigned to use e-cigarettes quit smoking at almost double the rate of people who were randomly assigned to nicotine replacement therapy.
我们仍然不确定电子烟的增加是否会导致成年人吸烟的减少。关于这个问题的最佳研究发表在今年早些时候的《新英格兰医学杂志》上。对电子烟的随机试验显示，被随机分配使用电子烟的人戒烟的速度几乎是随机分配尼古丁替代疗法的两倍。
But while e-cigarettes performed better than nicotine replacement therapy in the study, they only helped a minority of participants in the vaping group quit.
然而，尽管电子烟在研究中比尼古丁替代疗法效果更好，但它们只帮助了电子烟小组中的少数参与者戒烟。
On the other hand, there is strong evidence that e-cigarettes may act as a gateway to traditional cigarette smoking among youth. The National Academies of Sciences, Engineering, and Medicine report on the health impact of e-cigarettes assessed 10 high-quality studies on this gateway question, and they all pointed to the same effect.
另一方面，有强有力的证据表明，电子烟可能会成为年轻人吸传统香烟的途径。美国国家科学院、工程院和医学院关于电子烟对健康影响的报告评估了10项针对这一入门问题的高质量研究，它们都指出了同样的影响。
“The evidence base was large enough and consistent enough and strong enough to conclude that there’s an association between e-cigarette use and ever-use of combustible tobacco [cigarettes],” said Adam Leventhal, a member of the report committee, last January. But what’s less clear is whether young people are just more likely to try cigarettes after vaping, or whether they then go on to become long-term smokers.
去年1月，报告委员会成员Adam Leventhal说：“证据基础足够大、足够一致、足够有力，足以得出结论，电子烟的使用与一直使用可燃烟草(香烟)之间存在关联。”但不太清楚的是，年轻人是否更有可能在吸完电子烟后尝试卷烟，或者他们会尝试继而成为长期吸烟者。
Either way, this is a very important finding because another key question about the introduction of e-cigarettes to the market has been what impact they’ll have on youth smoking rates, which have dropped precipitously in recent years. Right now, like many e-cigarette health questions, we don’t know the results for certain. But it’s probably time we start paying attention to the possibilities.
无论如何，这是一个非常重要的发现，因为电子烟进入市场的另一个关键问题是，它们将对近年来急剧下降的青少年吸烟率产生何种影响。现在，像许多电子烟健康问题一样，我们也不知道确切的结果。但现在也许我们该开始关注这些可能性了。
