Sympathomimetic Effects of Acute E‐Cigarette Use: Role of Nicotine and Non‐Nicotine Constituents

Moheimani, Roya; Bhetraratana, May; Peters, Kacey M.; Yang, Benjamin; Yin, Fen; Gornbein, Jeffrey; Araujo, Jesús A.; Middlekauff, Holly R.

doi:10.1161/jaha.117.006579

Cited by 117 publications

(102 citation statements)

References 64 publications

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“…The vertical dashed line represents no effect, and plots to the right of the vertical dashed line indicate that the effect of ECN is greater than that of EC0. The results of most [8,16,34] but not all [2,9] of these acute vaping studies were consistent with the notion that nicotine-and not the non-nicotine constituents-in the EC aerosol was responsible for the acute sympathomimetic effects of EC vaping. The overall mean differences between the ECN and EC0 studies across all studies was 3.73 mmHg (95% CI 0.59-6.87; p = 0.02) for for SBP, 3.25 mmHg (95% CI 1.21-5.30; p = 0.0018) for DBP and 6.44 bpm (95% CI The forest plot of each study represents the mean differences between TCs and ECs, with the corresponding lower and upper 95% confidence bounds.…”

Section: Acute Autonomic Cardiovascular Effects Of Ecn Versus Ec0 Vapingsupporting

confidence: 76%

Cardiovascular autonomic effects of electronic cigarette use: a systematic review

2020

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Purpose Electronic cigarettes (ECs) are the fastest growing tobacco product in the USA, and ECs, like tobacco cigarettes (TCs), have effects on the cardiovascular autonomic nervous system, with clinical implications. The purpose of this review was to collect and synthesize available studies that have investigated the autonomic cardiovascular effects of EC use in humans. Special attention is paid to the acute and chronic effects of ECs, the relative contributions of the nicotine versus non-nicotine constituents in EC emissions and the relative effects of ECs compared to TCs. Methods Using the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, we conducted a literature search of the Ovid PubMed and Embase databases on 6 December 2019 using keywords in titles and abstracts of published literature. Acute (minutes to hours) and chronic (days or longer) changes in heart rate variability (HRV), heart rate (HR) and blood pressure (BP) were used as estimates of cardiovascular autonomic effects. Results Nineteen studies were included in this systematic review, all of which used earlier generation EC devices. Acute EC vaping increased HR and BP less than acute TC smoking. Nicotine but not non-nicotine constituents in EC aerosol were responsible for the sympathoexcitatory effects. The results of chronic EC vaping studies were consistent with a chronic sympathoexcitatory effect as estimated by HRV, but this did not translate into chronic increases in HR or BP. Conclusions Electronic cigarettes are sympathoexcitatory. Cardiac sympathoexcitatory effects are less when vaping using the earlier generation ECs than when smoking TCs. Additional studies of the latest pod-like EC devices, which deliver nicotine similarly to a TC, are necessary.

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Section: Acute Autonomic Cardiovascular Effects Of Ecn Versus Ec0 Vapingsupporting

confidence: 76%

Cardiovascular autonomic effects of electronic cigarette use: a systematic review

2020

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“…HRV analysis revealed patterns of change indicative of sympathovagal disbalance in the control of the mouse heart due to vaping where LF was increased, HF was decreased and LF/HF ratio increased. These changes are in line with what has been shown in human subjects who use tobacco cigarettes and electronic cigarettes 30 . HF is considered an index of parasympathetic modulation of the heart rate, and LF is considered an index of sympathetic modulation, but the actual contribution of the sympathetic and parasympathetic systems to HRV parameters in normal and abnormal physiology are still being dissected 26 .…”

Section: Discussionsupporting

confidence: 91%

Vaping Perpetuates Cardiac Electrical Instability

Abou-Assali

Chang

Reiser

et al. 2019

Preprint

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Background: Tobacco cigarette smoking is on the decline, but the usage of electronic nicotine delivery systems (ENDS) is gaining popularity, specifically in the teen and young adult age groups. While the cardiac toxicity of tobacco cigarette smoking has been widely studied and is well established, the possible cardiac toxicity of ENDS products and their design characteristics, such as added flavorings, are largely underexplored. Vaping, a form of electronic nicotine delivery, uses "e-liquid" to generate "e-vapor", a smoke-like aerosolized mixture of nicotine and flavors. Here, we tested the hypothesis that vaping results in cardiac electrophysiological instability and arrhythmogenesis. We thus investigated how e-liquids with different flavors affect cardiac in-vitro and in-vivo toxicity, in cell culture and in animals.Methods: Three e-liquids with vanilla, cinnamon or fruit flavors were studied. We quantified apoptosis and oxygen consumption rate in HL-1 cells cultured with e-vapors extracts. In human iPSC derived ventricular cardiomyocytes (hiPSC-CM) cultured with e-vapor extract, beating frequency and repolarization duration were measured using multiple electrode arrays (MEA). Mass spectrometry (GC-MS) was used to analyze the composition of the e-vapors.Telemetric ECGs were obtained in freely moving C57BL/6J mice exposed to vanilla flavored evapor for 10 weeks and heart rate variability was analyzed (HRV). In-vivo inducibility of ventricular tachycardia as well as optical mapping of voltage in isolated Langendorff-perfused hearts were also carried out.Results: E-vapor caused a dose dependent increase in toxicity in Hl-1 myocytes and e-vapors containing vanilla and cinnamon flavorings, as indicated by GC-MS, were more toxic, and inhibited cellular respiration more than the fruit flavored e-vapor. In hiPSC-CM cultured with 25% cinnamon flavored e-vapor for 24 hours, beating frequency increased, and the field potential duration significantly increased compared to air control. Inhalation exposure to vanilla flavored e-vapor for 10 weeks caused significant effects on HRV. Additionally, inducible VT was significantly longer, and in optical mapping, the magnitude of ventricular action potential duration alternans was significantly larger in the exposed mice compared to control Conclusion: The widely popular flavored ENDS are not harm free, and they show potential toxicity to the heart, in-vitro, and in vivo. Further studies are needed to further assess their cardiac safety profile, and long-term health effects.

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“…Importantly, in young healthy nonsmokers, acute inhalation of e-cig vapor increases both systolic and diastolic BP and heart rate (24). In another study, increased heart rate variability was reported following exposure to e-cig with nicotine, but not to e-cig without nicotine, indicating a shift in cardiac sympatho-vagal balance toward sympathetic predominance (101). In young, normotensive nonsmokers, Fogt et al (48) found that e-cig inhalation preferentially increased both resting and exercise diastolic BP 40 min following nicotine inhalation.…”

Section: Nicotine and The Ras In Cardiovascular Dysfunctionmentioning

confidence: 93%

Nicotine and the renin-angiotensin system

Oakes

Fuchs

Gardner

et al. 2018

American Journal of Physiology-Regulatory, Integrative and Comp

275

268

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Cigarette smoking is the single most important risk factor for the development of cardiovascular and pulmonary diseases (CVPD). Although cigarette smoking has been in constant decline since the 1950's, the introduction of e-cigarettes or electronic nicotine delivery systems 10 years ago has attracted former smokers as well as a new generation of consumers. Nicotine is a highly addictive substance, and it is currently unclear whether e-cigarettes are "safer" than regular cigarettes or whether they have the potential to reverse the health benefits, notably on the cardiopulmonary system, acquired with the decline of tobacco smoking. Of great concern, nicotine inhalation devices are becoming popular among young adults and youths, emphasizing the need for awareness and further study of the potential cardiopulmonary risks of nicotine and associated products. This review focuses on the interaction between nicotine and the renin-angiotensin system (RAS), one of the most important regulatory systems on autonomic, cardiovascular and pulmonary functions in both health and disease. The literature presented in this review strongly suggests that nicotine alters the homeostasis of the RAS by up-regulating the detrimental angiotensin converting enzyme (ACE)/Angiotensin (Ang)-II/Ang-II type 1 receptor (ATR) axis and down-regulating the compensatory ACE2/Ang-(1-7)/Mas receptor axis, contributing to the development of CVPD.

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Sympathomimetic Effects of Acute E‐Cigarette Use: Role of Nicotine and Non‐Nicotine Constituents

Cited by 117 publications

References 64 publications

Cardiovascular autonomic effects of electronic cigarette use: a systematic review

Cardiovascular autonomic effects of electronic cigarette use: a systematic review

Vaping Perpetuates Cardiac Electrical Instability

Nicotine and the renin-angiotensin system

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