Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

Abstract

Background Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID) DERR1-10.2196/29084

Clinical testing of the cardiovascular effects of e-cigarette substitution for smoking: a living systematic review

“…Our review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines [ 19 ], see Online Resource 1 PRISMA 2020 Checklist. The protocol was registered with PROSPERO #CRD42021239094 and published in a peer-reviewed journal [ 20 ].…”

“…The first process was the exclusion of articles based on titles and abstracts to remove in vitro and animal studies, commentary articles, and false retrievals. Details of the exclusion criteria are available in the published protocol [ 20 ].…”

Impact of Electronic Cigarette use on Cardiovascular Health: Current Evidence, Causal Pathways, and Public Health Implications

“…28 Collectively, with respect to the health impacts of active ecigarette use on CV health, several study findings display that even limited frequency and overall duration of e-cigarette use has been associated with increased heart rate and diastolic BP, as well as decreased oxygen saturation. 8,9 It should be noted, though, that while corroborating evidence from multiple investigations exists regarding the profound effects of e-cigarette use on BP and oxygen saturation, conflicting evidence currently exists on the effects regarding heart rate, stroke and/or coronary heart disease, particularly among longterm regular e-cigarette users. 29 Even so, large scale epidemiological findings arising from the U.S. National Health Interview Survey (n = 16,855) revealed that e-cigarette users, compared with non-users, remained in excess of 4-fold more likely to have a myocardial infarction (OR 4.09, 95% CI: 1.29-12.98).…”

“…7 While the etiological association between conventional tobacco smoking and cardiovascular (CV) diseases (CVD) is well established, to date insights regarding the potential long-term health impacts of e-cigarette use on CV health in adults remain conflicting, while in the young it remains to be elucidated. 8 The present review summarizes the current evidence regarding the health impacts of e-cigarette use on CV health in both adults and youth, elucidating its potential causal pathways and public health implications.…”

“…7 While the etiological association between conventional tobacco smoking and cardiovascular (CV) diseases (CVD) is well established, to date insights regarding the potential long-term health impacts of e-cigarette use on CV health in adults remain conflicting, while in the young it remains to be elucidated. 8…”