E-cigarette Use and Indicators of Cardiovascular Disease Risk
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Purpose of Review
The aim is to provide a detailed review of literature from studies examining the relation of electronic cigarette (e-cigarette) use to indicators of risk for cardiovascular disease. In addition to discussing clinical and cell culture studies, we discuss possible mechanisms for the observed effects.
Studies have compared the effect of e-cigarette use (or vapor) and combustible cigarette smoking on a range of measures. These include heart rate, blood pressure, and vagal tone; aortic stiffness and endothelial function; platelet aggregation and adhesion; expression of genes for antioxidant defense and immune system function; and indices of oxidative stress. The majority of studies found some evidence of a significant risk effect for e-cigarettes, although the evidence was not totally consistent within and between studies. Suggestive evidence also implicates a possible effect of e-cigarettes on inflammation processes. The magnitude of the effect for e-cigarettes was sometimes lower than those found for cigarettes, but several studies showed comparable effects.
The findings overall provide evidence of some risk to the cardiovascular system from e-cigarettes, but conclusions are qualified because each study was heterogeneous in its design and evidence on cardiac morbidity from prospective human studies is not yet available. The studies have helped to identify possible agents and mechanisms for producing risk, including reactive oxygen species and oxidative stress, fine and ultrafine particles, and nicotine. Longitudinal data from clinical and epidemiological studies are needed to clarify these relationships in healthy populations and investigate the impact of e-cigarette use among persons with pre-existing cardiovascular disease.
KeywordsE-cigarettes Cardiovascular disease Heart disease Vascular disease
Compliance with Ethical Standards
Conflict of Interest
Rebecca J. Schweitzer and J. Dusty Behner each declare no potential conflicts of interest.
Dr. Wills reports grants from National Cancer Institute during the conduct of the study.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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