Cardiovascular Perspective of the Promises and Perils of E-Cigarettes

Bhatnagar, Aruni

doi:10.1161/circresaha.116.308723

Cited by 39 publications

(34 citation statements)

References 26 publications

(27 reference statements)

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“…These data should cast serious doubt concerning the presumed safety of e‐cigarettes, and could be attributed, at least in part, to the high “sensitivity” of the cardiovascular system, and the nonlinear dose‐response relationship for toxicity 84, 85. Thus, even exposure to low levels of harmful constituents “as claimed” with e‐cigarettes has the potential to induce pronounced effects 86. This notion is consistent with findings that switching to e‐cigarettes did not significantly reduce the risk of acute myocardial infarction or stroke 87…”

Section: Discussionsupporting

confidence: 82%

Short‐Term E‐Cigarette Exposure Increases the Risk of Thrombogenesis and Enhances Platelet Function in Mice

Qasim

Karim

Silva‐Espinoza

et al. 2018

JAHA

100

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BackgroundCardiovascular disease is the main cause of death in the United States, with smoking being the primary preventable cause of premature death, and thrombosis being the main mechanism of cardiovascular mortality in smokers. Due to the perception that electronic/e‐cigarettes are “safer/less harmful” than conventional cigarettes, their usage—among a variety of ages—has increased tremendously during the past decade. Notably, there are limited studies regarding the negative effects of e‐cigarettes on the cardiovascular system, which is also the subject of significant debate.Methods and ResultsWe employed a passive e‐VapeTM vapor inhalation system and developed an in vivo whole‐body e‐cigarette mouse exposure protocol that mimics real‐life human exposure scenarios/conditions and investigated the effects of e‐cigarettes and clean air on platelet function and thrombogenesis. Our results show that platelets from e‐cigarette–exposed mice are hyperactive, with enhanced aggregation, dense and α granule secretion, activation of the αIIbβ3 integrin, phosphatidylserine expression, and Akt and ERK activation, when compared with clean air–exposed platelets. E‐cigarette–exposed platelets were also found to be resistant to inhibition by prostacyclin, relative to clean air. Furthermore, the e‐cigarette–exposed mice exhibited a shortened thrombosis occlusion and bleeding times.ConclusionsTaken together, our data demonstrate for the first time that e‐cigarettes alter physiological hemostasis and increase the risk of thrombogenic events. This is attributable, at least in part, to the hyperactive state of platelets. Thus, the negative health consequences of e‐cigarette exposure should not be underestimated and warrant further investigation.

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Section: Discussionsupporting

confidence: 82%

Short‐Term E‐Cigarette Exposure Increases the Risk of Thrombogenesis and Enhances Platelet Function in Mice

Qasim

Karim

Silva‐Espinoza

et al. 2018

JAHA

100

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“…124 Nevertheless, some health advocates find the residual risk associated with e-cigarettes acceptable. 201 They believe that e-cigarettes are a safer alternative to combustible cigarettes and their widespread use and acceptance could lessen the burden of tobacco-induced disease. Others, however, are less certain and remain concerned about the potential health effects of nicotine as well as the chemicals present in e-cigarette aerosols.…”

Section: The Personal Environmentmentioning

confidence: 99%

“…Others, however, are less certain and remain concerned about the potential health effects of nicotine as well as the chemicals present in e-cigarette aerosols. 201 They are also concerned about the uptake of e-cigarettes by youth who would not otherwise smoke cigarettes and the renormalization of smoking, 198 which has been a major contributing factor to the decline in the number of smokers in the last 5 decades. Regardless, of the impact e-cigarettes might have on cardiovascular health in future, the advent and spread of e-cigarettes is an important case study of how environmental factors – society, culture, advertisement and regulatory policy – influence CVD risk and affect cardiovascular health.…”

Section: The Personal Environmentmentioning

confidence: 99%

Environmental Determinants of Cardiovascular Disease

Bhatnagar

2017

Circulation Research

Self Cite

429

268

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Many features of the environment have been found to exert an important influence on cardiovascular disease (CVD) risk, progression, and severity. Changes in the environment due to migration to different geographic locations, modifications in lifestyle choices, and shifts in social policies and cultural practices alter CVD risk, even in the absence of genetic changes. Nevertheless, the cumulative impact of the environment on CVD risk has been difficult to assess and the mechanisms by which some environment factors influence CVD remain obscure. Human environments are complex; and their natural, social and personal domains are highly variable due to diversity in human ecosystems, evolutionary histories, social structures, and individual choices. Accumulating evidence supports the notion that ecological features such as the diurnal cycles of light and day, sunlight exposure, seasons, and geographic characteristics of the natural environment such altitude, latitude and greenspaces are important determinants of cardiovascular health and CVD risk. In highly developed societies, the influence of the natural environment is moderated by the physical characteristics of the social environments such as the built environment and pollution, as well as by socioeconomic status and social networks. These attributes of the social environment shape lifestyle choices that significantly modify CVD risk. An understanding of how different domains of the environment, individually and collectively, affect CVD risk could lead to a better appraisal of CVD, and aid in the development of new preventive and therapeutic strategies to limit the increasingly high global burden of heart disease and stroke.

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“…Furthermore, the lack of standardization across brands and product types contributes to uncertainty surrounding chemical exposures. In light of the conflicting evidence, the implications of e‐cigarette use on cardiovascular health remain debated …”

Section: Discussionmentioning

confidence: 99%

“…In light of the conflicting evidence, the implications of e-cigarette use on cardiovascular health remain debated. 42,43 The safety of e-cigarettes and the merits of harm-reduction approaches are contested, but there is general consensus in the scientific community that e-cigarettes are less harmful than traditional tobacco cigarettes. 21,44 However, additional longitudinal research on both the impact of e-cigarette use on cigarette use and safety of e-cigarettes is needed before ecigarettes can be recommended with confidence for smoking cessation specifically for smokers with CVD or for the general population.…”

Section: Discussionmentioning

confidence: 99%

Electronic Cigarette Prevalence and Patterns of Use in Adults with a History of Cardiovascular Disease in the United States

Stokes

Collins

Berry

et al. 2018

JAHA

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BackgroundCharacterizing electronic cigarette (e‐cigarette) use patterns is important for guiding tobacco regulatory policy and projecting the future burden of tobacco‐related diseases. Few studies have examined patterns of e‐cigarette use in individuals with cardiovascular disease (CVD).Methods and ResultsWe examined e‐cigarette use in adults aged 18 to 89 years with a history of CVD, using data from the 2014 National Health Interview Survey. We investigated associations between ever and current e‐cigarette use and smoking with multivariable logistic regression. In a secondary analysis, we modeled the association between e‐cigarette use and a quit attempt over the past year. Former smokers with CVD who quit smoking within the past year showed 1.85 (95% confidence interval, 1.03, 3.33) times the odds of having ever used e‐cigarettes as compared with those who reported being “some days” current smokers. Current smokers who attempted to quit smoking within the past year showed significantly increased odds of ever having used e‐cigarettes (odds ratio, 1.70; 95% confidence interval, 1.25, 2.30) and currently using e‐cigarettes (odds ratio, 1.97; 95% confidence interval, 1.32, 2.95) as compared with smokers who had not attempted to quit over the past year.ConclusionsIndividuals with CVD who recently quit smoking or reported a recent quit attempt were significantly more likely to use e‐cigarettes than current smokers and those who did not report a quit attempt. Our findings may indicate that this population is using e‐cigarettes as an aid to smoking cessation. Characterizing emerging e‐cigarette use behaviors in adults with CVD may help to inform outreach activities aimed at this high‐risk population.

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Cardiovascular Perspective of the Promises and Perils of E-Cigarettes

Cited by 39 publications

References 26 publications

Short‐Term E‐Cigarette Exposure Increases the Risk of Thrombogenesis and Enhances Platelet Function in Mice

Short‐Term E‐Cigarette Exposure Increases the Risk of Thrombogenesis and Enhances Platelet Function in Mice

Environmental Determinants of Cardiovascular Disease

Electronic Cigarette Prevalence and Patterns of Use in Adults with a History of Cardiovascular Disease in the United States

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