E-Cigarettes and Cardiopulmonary Health: Review for Clinicians

Abstract

Electronic cigarettes (e-cigarettes) are battery powered electronic nicotine delivery systems that use a propylene glycol/vegetable glycerin base to deliver vaporized nicotine and flavorings to the body. E-cigarettes became commercially available without evidence regarding their risks, long-term safety, or utility in smoking cessation. Recent clinical trials suggest that e-cigarette use with counseling may be effective in reducing cigarette use but not nicotine dependence. However, meta-analyses of observational studies demonstrate that e-cigarette use is not associated with smoking cessation. Cardiovascular studies reported sympathetic activation, vascular stiffening, and endothelial dysfunction, which are associated with adverse cardiovascular events. The majority of pulmonary clinical trials in e-cigarette users included standard spirometry as the primary outcome measure, reporting no change in lung function. However, studies reported increased biomarkers of pulmonary disease in e-cigarette users. These studies were conducted in adults, but >30% of high school–age adolescents reported e-cigarette use. The effects of e-cigarette use on cardiopulmonary endpoints in adolescents and young adults remain unstudied. Because of adverse clinical findings and associations between e-cigarette use and increased incidence of respiratory diseases in people who have never smoked, large longitudinal studies are needed to understand the risk profile of e-cigarettes. Consistent with the Centers for Disease Control and Prevention recommendations, clinicians should monitor the health risks of e-cigarette use, discourage nonsmokers and adolescents from using e-cigarettes, and discourage smokers from engaging in dual use without cigarette reduction or cessation.

E-cigarette aerosol exacerbates cardiovascular oxidative stress in mice with an inactive aldehyde dehydrogenase 2 enzyme

“…This may provide a basis to understand how the heart as an organ may be more susceptible aldehyde-induced oxidative stress via NF-κB triggering a proinflammatory pathway. Ultimately, this study highlights the importance of considering the impact of genetics to develop a further understanding of the cardiovascular risks with e-cigarette aerosol use [ 59 ].…”

Cardiopulmonary Consequences of Vaping in Adolescents: A Scientific Statement From the American Heart Association

“…Currently available evidence is based largely on studies of young adults who were former smokers or nonsmokers. 2b A recent study in young healthy adults who were exclusive e-cigarette users found no long- or short-term effects on endothelial function. 64 However, this study used predominantly e-cigarettes with a lower nicotine concentration than the e-cigarettes that are popular among adolescents.…”

“…11 Furthermore, one must distinguish between tobacco cessation and nicotine cessation: E-cigarettes are partially successful at the former, although whether they are as good or better than other established/FDA-approved nicotine replacement therapies for nicotine cessation is debatable. 2b However, data in adolescent e-cigarette users are lacking. Indeed, although e-cigarettes in 1 study from the United Kingdom, where nicotine concentration was ≈40% lower than products in the United States, may be more effective than nicotine patches at tobacco cessation (18% versus 10%, respectively; relative risk, 1.83 [95% CI, 1.30–2.58; P <0.001]), their effectiveness in reducing nicotine consumption is absent, with 20% efficacy, whereas nicotine patches have 81% efficacy.…”

“…The focus of this scientific statement is to review the latest evidence of cardiopulmonary effects of e-cigarette use in the fastest-growing user group, adolescents. 2a,2b…”

The incidence of xerostomia in healthy population with e-cigarettes or combustible tobacco: a meta-analysis

“…A total of 10 studies were included [11][12][13][14][15][16][17][18][19], with a total sample size was 5161 cases. The results of the random-effects model Meta-analysis showed that the overall incidence of xerostomia was 27% [95% CI (0.17,0.37)] in the healthy smokers(Fig.…”