No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The association between e-cigarette use and cardiovascular disease among never and current combustible cigarette smokers: BRFSS 2016 & 2017
Abstract
Background:
The prevalence of e-cigarette use in the United States has increased rapidly. However, the association between e-cigarette use and cardiovascular disease remains virtually unknown. Therefore, we aimed to examine the association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers.
Methods:
We pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. We included 449,092 participants with complete self-reported information on all key variables. The main exposure, e-cigarette use, was further divided into daily or occasional use, and stratified by combustible-cigarette use (never and current). Cardiovascular disease, the main outcome, was defined as a composite of self-reported coronary heart disease, myocardial infarction, or stroke.
Results:
Of 449,092 participants, there were 15,863 (3.5%) current e-cigarette users, 12,908 (2.9%) dual users of e-cigarettes + combustible cigarettes, and 44,852 (10.0%) with cardiovascular disease. We found no significant association between e-cigarette use and cardiovascular disease among never combustible-cigarette smokers. Compared with current combustible-cigarette smokers who never used e-cigarettes, dual use of e-cigarettes + combustible cigarettes was associated with 36% higher odds of cardiovascular disease (odds ratio 1.36; 95% confidence interval, 1.18-1.56); with consistent results in subgroup analyses of premature cardiovascular disease in women <65 years and men <55 years old.
Conclusion:
Our results suggest significantly higher odds of cardiovascular disease among dual users of e-cigarettes + combustible cigarettes compared with smoking alone. These data, although preliminary, support the critical need to conduct longitudinal studies exploring cardiovascular disease risk associated with e-cigarette use, particularly among dual users.
... Data on the duration of EC use was not presented in most studies. Only two cross-sectional studies distinguished between occasional and daily use [26,64]. ...
... The overall quality of the prospective studies was generally high, as assessed by the JBI tool (Appendix S1 in Supplementary Materials), except for general inaccurate exposure measurement and lack of adjustment for former tobacco consumption (eight studies). Most of the cross-sectional studies were large, representative of the general population, had weighted data, and had a low risk of bias [26,64]. The primary aim of many studies was to compare EC users with smokers or non-users of tobacco or nicotine products, so they did not test for significance between DU and smokers. ...
... The best available of these studies had adjusted for tobacco consumption and found higher HbA1c levels in DUs than in ESCC, but significance levels were not tested [69]. Four of the good-quality surveys investigated cardiovascular risk factors and found that DUs had a significantly higher OR of cardiovascular disease [26], significantly higher prevalence OR of cardiovascular risk factors and diagnosis of metabolic syndrome [21], significantly higher OR of elevated human c-reactive protein (CRP) [71], significantly higher risk of stroke [73], significantly higher prevalence of arrythmia [66], significantly higher OR of elevated CRP [71], and significantly higher OR of abdominal obesity than ESCC [22]. The two remaining surveys found higher OR of myocardial infarction and stroke, but significance level was not tested [65,74], and higher but not significant OR of hypertension [27] in DUs than in ESCC. ...
Background:
A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world.
Methods:
A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC).
Results:
Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health.
Conclusion:
Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".
... Eight studies (45, 48,76,78,82,83,85,86) assessed the odds of having CVD in e-cigarette users compared to nonsmokers; five (45, 76, 78, 82, 83) concentrated on daily e-cigarette users, two of which assessed (45, 82) exclusive e-cigarette users. ...
... Indicators of CVD included self-reported premature CVD (i.e., disease age <65 years), myocardial infarction, ischemic attack (stroke), congestive heart failure, peripheral artery disease, and coronary heart disease. All evidence was cross-sectional and found no significant difference in the odds of CVD between daily e-cigarette users or exclusive e-cigarette users and non-smokers (45, 76,78,82,83). One study looking at multiple CVD outcomes did find significantly higher odds of myocardial infarction for exclusive e-cigarette users compared to non-smokers, but there was no difference for stroke or coronary heart disease (76). ...
... Twenty-five studies (45-52, 56, 72-88) explored cardiovascular (CV) health including cardiovascular disease (CVD) (n = 8), blood pressure (n = 14), biomarkers of lipid metabolism (n = 8), and CV function (n = 8). Nineteen studies assessed the association of daily e-cigarette use with CV health, five RCT(50-52, 73, 87), and 14 cross-sectional studies(45,47,49,56,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). ...
Introduction
Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report.
Methods
Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp .
Results
A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters.
Conclusions
This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.
... 6,8 A number of epidemiological studies have identified an association between ENDS use and cardiovascular disease among adults. [9][10][11][12][13] However, these studies are predominately cross-sectional [9][10][11][12][13] and therefore subject to reverse causation, [14][15][16] as adults who smoke cigarettes may start using ENDS after being diagnosed with cardiovascular disease. 17 Additionally, although most adults who use ENDS have a history of cigarette use, 18 many of these studies do not adequately account for past smoking history. ...
... 6,8 A number of epidemiological studies have identified an association between ENDS use and cardiovascular disease among adults. [9][10][11][12][13] However, these studies are predominately cross-sectional [9][10][11][12][13] and therefore subject to reverse causation, [14][15][16] as adults who smoke cigarettes may start using ENDS after being diagnosed with cardiovascular disease. 17 Additionally, although most adults who use ENDS have a history of cigarette use, 18 many of these studies do not adequately account for past smoking history. ...
... Additionally, some cross-sectional studies have reported higher odds of cardiovascular disease for respondents using both cigarettes and ENDS versus respondents exclusively smoking cigarettes. 11,12 However, these studies did not account for cigarette smoking intensity nor cumulative pack-years of exposure. In our study, respondents using both cigarettes and ENDS had slightly lower mean cigarettes pack-years (CPY) at baseline (23.5-23.7) ...
Introduction
The cardiovascular health effects of electronic nicotine delivery systems (ENDS) use are not well characterized, making it difficult to assess ENDS as a potential harm reduction tool for adults who use cigarettes.
Methods
Using waves 1-5 of the Population Assessment of Tobacco & Health Study (2013-2019), we analyzed the risk of self-reported incident diagnosed myocardial infarction (MI; 280 incident cases) and stroke (186 incident cases) associated with ENDS and/or cigarette use among adults aged 40+ using discrete time survival models. We employed a time-varying exposure lagged by one wave, defined as exclusive or dual established use of ENDS and/or cigarettes every day or some days, and controlled for demographics, clinical factors, and past smoking history.
Results
The analytic samples (MI=11,031; stroke=11,076) were predominantly female and non-Hispanic White with a mean age of 58 years. At baseline, 14.2% of respondents exclusively smoked cigarettes, 0.6% exclusively used ENDS, and 1.0% used both products. Incident MI and stroke were rare during follow-up (<1% at each wave). Compared to no cigarette or ENDS use, exclusive cigarette use increased the risk of MI (aHR 1.99, 95% CI 1.40-2.84) and stroke (aHR 2.26, 95% CI 1.51-3.39), while exclusive ENDS use (MI: aHR 0.61, 95% CI 0.12-3.04; stroke: aHR 1.74, 95% CI 0.55-5.49) and dual use (MI: aHR 1.84, 95% CI 0.64-5.30; stroke: aHR 1.12, 95% CI 0.33-3.79) were not significantly associated with the risk of either outcome.
Conclusions
Compared to non-use, exclusive cigarette use was associated with an increased risk of self-reported incident diagnosed cardiovascular disease over a five-year period, while ENDS use was not associated with a statistically significant increase in the outcomes.
Implications
Existing literature on the health effects of ENDS use has important limitations, including potential reverse causation and improper control for cigarette smoking. We accounted for these issues by using a prospective design and adjusting for current and former smoking status and cigarette pack years. In this context, we did not find that ENDS use was associated with a statistically significant increase in self-reported incident diagnosed myocardial infarction or stroke over a five-year period. While more studies are needed, this analysis provides an important foundation and key methodological considerations for future research on the health effects of ENDS use.
... Most cardiovascular diseases have both biomedical and psychosocial factors in the pathogenesis; in terms of clinical symptoms, there are both somatic and psychological symptoms. Growing research is finding a strong link between mood and morbidity and mortality of CVD, as one of the common public health problems worldwide [41], arousing social concern [42]. With the transition from the traditional biomedical model to the modern biopsychosocial medical model, the psychosomatic relationship of CVD has attracted more attention. ...
... A recent study led by the tobacco industry claims that electronic nicotine delivery systems (ENDS) are less harmful than cigarettes [115,116]. However, ENDS may be more toxic than inhaled ones at low in conventional cigarettes and tobacco products, but they are not harmless, and there are risks associated with use and secondhand exposure [41,117]. ENDS linked to increased risk of cardiovascular disease Association [118,119]. ...
The irreversible termination of individual life activities and metabolism means all fatal problems ultimately terminate the heart function. It’s very important to protect the patient’s life if we have treatment to maintain heart function and care about patients’ heart response. It is known that many diseases induced heart dysfunction including Chagas disease, burn injury, smoking and other bad stresses. Chronic stress causes these physical symptoms and emotional symptoms. Due to the awareness created by the media and internet, patients are generally aware that they should seek help immediately for chest pain. Therefore, attention and studies on stress-induced heart dysfunction would help uncover the pathophysiological mechanisms of cardiac response to non-heart diseases and provide an insight of heart-protection drugs. At the same time, physicians should be aware of this new condition and how to diagnose and treat it, even though the causal mechanisms are not yet fully understood. This special chapter will discuss on the cardiac response to the stresses especially on our associated research in recent decades such as Trypanosoma cruzi (T. cruzi)-induced cardiomyopathy and burn injury–induced cardiomyopathy, and on some very popular stresses such as behavior, motion, mental, and smoking.
... 1 Inhalation of e-cigarette aerosols among young, healthy adults induces inflammation and oxidative stress. 1 Two large cross-sectional studies reported no significant association between exclusive e-cigarette use and cardiovascular disease (CVD). 2,3 However, longitudinal studies are essential to assess the association of e-cigarette use with incident CVD. ...
... Other recent crosssectional analyses have also reported no significant association between e-cigarette use and CVD outcomes. 2,3 Limitations of this study include use of selfreported, nonadjudicated outcomes that could result in misclassification, a short follow-up period given the progressive development of CVD, and a nonuse reference group that includes former cigarette users. Larger studies with more cardiovascular outcome events and longer follow-up are warranted. ...
... Dual TP use is problematic, as it exposes youth to more tobacco toxicants than single-product use as seen in biomarker data studies [17,18], and a previous PATH study found dual TP use is associated with increased nicotine dependence [19]. Furthermore, dual use of cigarettes and e-cigarettes is associated with higher odds of cardiovascular disease than when each product is used alone [20]. ...
... A study using data from the 2017 National Survey on Drug Use and Health found that 5.3% of youth (aged [12][13][14][15][16][17] reported binge drinking in the past 30-days [21], which is a concern considering the reinforcing relationship between tobacco and alcohol, in which alcohol is primary trigger for initiation of tobacco use and relapse back to tobacco use after quit attempts [5,20,21]. Given that alcohol consumed in excessive amounts (i.e., binge drinking) and dual TP use are linked to long-term health consequences (i.e., heart diseases, stroke, cancer, and substance use disorders) [22][23][24], especially when youth start using these substances at younger ages, it is imperative to understand the age of initiation of the polysubstance use behavior of past 30-day dual TP use and binge drinking. ...
Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7–5.2) and 2.0% (95% CI: 1.2–2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.
... The most recent large-scale clinical trials did not report a significantly increased risk of e-cigarette use. A large cohort of 449,092 participants from the US found no association between e-cigarette use and prevalent cardiovascular disease (composite of coronary heart disease, myocardial infarction, or stroke) among individuals who never smoked [66]. In contrast, dual-use (vaping and smoking) was associated with a 36% (odds ratio 1.36, 95% confidence interval 1.18-1.56) ...
Smoking tobacco cigarettes is a significant (cardiovascular) health risk factor. Although the number of tobacco cigarette users declined over the last decades, shisha smoking and e-cigarette vaping partially compensated for this health benefit. E-cigarettes may create highly addicted dual users (vaping and smoking). E-cigarettes seem not to represent a healthier alternative to tobacco smoking, although they may be less harmful. E-cigarette vaping causes oxidative stress, inflammation , endothelial dysfunction, and associated cardiovascular sequelae. This is primarily due to a significant overlap of toxic compounds in the vapor compared to tobacco smoke and, accordingly, a substantial overlap of pathomechanistic features between vaping and smoking. Whereas the main toxins in vapor are reactive aldehydes such as formaldehyde and acrolein, the toxic mixture in smoke is more complex, comprising particulate matter, reactive gases, transition metals, volatile organic compounds, and N-nitrosamines. However, it seems that both lifestyle drugs impair endothelial function to a quite similar extent, which may be due to the role of oxidative stress as the central pathomechanism to mediate endothelial dysfunction and vascular damage. Finally, the main selling argument for e-cigarette use that they help to quit smoking and get rid of nicotine addiction may be false because it seems that e-cigarettes instead trigger the opposite-younger entrance age and more frequent use. With our review, we summarize the adverse health impact of tobacco cigarettes and e-cigarettes, emphasizing the detrimental effects on endothelial function and cardiovascular health.
... This may be observed as no difference in health-related harms between dual users and single product users or increased harms among dual users. Notably, most of these studies focus on the health-related impacts of either smoking or vaping, but not both [14][15][16][17][18] . Finally, much research remains inconclusive surrounding the harms associated with the dual use of cigarettes and e-cigarettes, as well as with regard to how these impacts differ between individuals who are solely users of either cigarettes or e-cigarettes 12 . ...
Introduction
E-cigarettes have been steadily increasing in popularity, both as
cessation methods for smoking and for recreational and social reasons. This
increase in vaping may pose cardiovascular and respiratory risks. We aimed to
assess respiratory symptoms in youth users of e-cigarettes and cigarettes.
Methods
A retrospective survey design was utilized to assess Canadian youth aged
16–25 years. Participants were recruited from the Ontario Tobacco Research Unit
Youth and Young Adult Research Registration Panel November 2020 to March
2021. A total of 3082 subjects completed the baseline survey. Of these, 2660
individuals who did not have asthma were included in the analysis. The exposure
of interest was pack-equivalent years, a novel measure of vaping exposure
equivalent conceptually to cigarette pack years incorporating number of puffs
per day, number of days vaped per month, and number of years vaped. Respiratory
symptoms were measured using the five-item Canadian Lung Health Test. Poisson
regression analyses were performed while adjusting for demographic confounders,
stratified by smoking status. A non-stratified model tested the interaction of status
and vaping dose and the effect of vaping device used was assessed among ever
vapers. Analyses controlled for demographic characteristics, use of cannabis and
alcohol, and survey date.
Results
Each additional puff year increased the rate ratio (RR) of respiratory
symptoms by a factor of 11.36 (95% CI: 4.61–28.00; p
... 1,27 Health effects of concurrent ENDS and traditional cigarette use include higher odds of stroke 29 and cardiovascular disease. 30 Additionally, recent analysis of 50 000 individuals from the Canadian Community Health Survey found that those who concurrently use ENDS and traditional cigarettes report high prevalence of adverse mental health status 31 and a subsample of 3800 individuals from the National Longitudinal Study of Adolescent to Adult Health had similar findings. 32 Although the temporal association between concurrent use and some health outcomes is unclear, it is important that medical providers communicate the potential increased health risks associated with concurrent ENDS and traditional cigarette use. ...
Introduction
Our primary purpose is to understand comorbidities and health outcomes associated with electronic nicotine delivery systems (ENDS) use.
Methods
Study participants were Kaiser Permanente (KP) members from eight US regions who joined the Kaiser Permanente Research Bank (KPRB) from September 2015 through December 2019 and completed a questionnaire assessing demographic and behavioral factors, including ENDS and traditional cigarette use. Medical history and health outcomes were obtained from electronic health records. We used multinomial logistic regression to estimate odd ratios (ORs) and 95% confidence intervals (CIs) of current and former ENDS use according to member characteristics, behavioral factors, and clinical history. We used Cox regression to estimate hazard ratios (HRs) and 95% CIs comparing risk of health outcomes according to ENDS use.
Results
Of 119 593 participants, 1594 (1%) reported current ENDS use and 5603 (5%) reported past ENDS use. ENDS users were more likely to be younger, male, gay or lesbian, and American Indian / Alaskan Native or Asian. After adjustment for confounding, current ENDS use was associated with current traditional cigarette use (OR = 39.55; CI:33.44-46.77), current marijuana use (OR = 6.72; CI:5.61-8.05), history of lung cancer (OR = 2.64; CI:1.42-4.92), non-stroke cerebral vascular disease (OR = 1.55; CI:1.21-1.99), and chronic obstructive pulmonary disease (OR = 2.16; CI:1.77-2.63). Current ENDS use was also associated with increased risk of emergency room (ER) visits (HR = 1.17; CI: 1.05-1.30) and death (HR = 1.84; CI:1.02-3.32).
Conclusions
Concurrent traditional cigarette use, marijuana use, and comorbidities were prevalent among those who used ENDS, and current ENDS use was associated with an increased risk of ER visits and death. Additional research focused on health risks associated with concurrent ENDS and traditional cigarette use in those with underlying comorbidities is needed.
... The data would need further validation and longitudinal surveillance since those currently available are derived from cross-sectional studies. 15,16 To date, there are no conclusive data relating to the long-term cardiopulmonary effects of the use of e-cigarettes, partly due to their recent marketing and also as they are devices that are constantly evolving from both an engineering and chemical composition point of view. ...
Electronic cigarettes (e-cigarettes) are battery-powered devices containing a liquid based on propylene glycol or vegetable glycerin, compounds which, when vaporized, act as a vehicle for nicotine, flavours, and other chemical components. These devices have been marketed without clear evidence of risks, long-term safety, and efficacy as a means of traditional smoking cessation. Recent clinical studies have shown how the use of the e-cigarette, combined with adequate psychological support, can be effective in reducing traditional smoking but not nicotine addiction. However, meta-analyses of observational studies have not confirmed this efficacy. Several studies have also highlighted an increase in sympathetic tone, vascular stiffness, and endothelial dysfunction, all factors associated with an increased cardiovascular risk. Clinicians, therefore, should carefully monitor the possible risks to public health deriving from the use of e-cigarettes and should discourage non-smokers and adolescents from using such devices. Finally, particular attention should be paid to smokers so that the combined use of electronic and traditional cigarettes can be limited as much as possible.
... Considering the increasing prevalence and mortality of CVD, researchers started to focus on the potential linkage between the rising use of electronic cigarettes and the increased prevalence of cardiovascular disease. Several epidemiological studies showed positive associations between electronic cigarettes and CVD (29,30) in line with our study. Additionally, our result showed that the participants who simultaneously smoked electronic and combustible cigarettes significantly increased the risk of CVD. ...
The joint effect of electronic cigarette smoking and insufficient sleep duration on cardiovascular disease (CVD) was unclear. This cross-sectional study aimed to evaluate the association between electronic cigarettes, sleep duration, and risk of CVD among American adults. The participants who completed the survey from the behavioral risk factor surveillance system in 2020 were included in this study. The status of electronic cigarette smoking was divided into never, former, and current use. The duration of sleep was categorized into insufficient (<6 h), appropriate (6–9 h), and excessive (>9 h) groups. The CVD group was defined as a patient having any of the following conditions: heart attack, coronary heart disease, or stroke according to self-report. The multivariate logistic regression model was adopted to determine the association between electronic cigarettes, sleep duration, and the risk of CVD. Sensitivity analyses were performed to assess the joint effects on the risk of CVD subtypes, including heart attack, coronary heart disease, and strokes, respectively. Subgroup analyses were performed to estimate the joint effects within the stratum of the age group. The total number of participants included in the present study was 253,561. Of which, 22,908 patients had CVD. In total, 61,293 participants had previously or currently used electronic cigarettes and 37,429 participants had inappropriate sleep duration. Former electronic cigarette users had a 10.8% increased risk of having CVD (OR = 1.108, 95% CI: 1.001–1.227) compared to users who never had electronic cigarettes. Insufficient and excessive sleep durations are associated with increased risks of CVD (OR = 1.592, 95% CI: 1.460–1.735; OR = 1.523, 95% CI: 1.320–1.758). The participants with current vaping status and lack of sleep had a 159.6% increased risk of CVD (OR = 2.596, 95% CI: 1.810–3.723). Sensitivity analyses found similar joint effects of current vaping and insufficient sleep on the risk of heart attack, coronary heart attack, and stroke. The subgroup analyses across each age stratum found that the middle-aged group is most vulnerable to the joint effect of current vaping and insufficient sleep. This study found that both current vaping and inappropriate sleep duration were associated with CVD. Additionally, there was a significant joint effect of current vaping and insufficient sleep on the risk of CVD, especially for middle-aged participants.
... Since many EC users continue to smoke TCs [7] and may be at increased risk of cardiovascular disease compared to only cigarette smokers [37,38], the smoking status of study participants is needed to distinguish the impacts of EC from that of TC or dual use. Moreover, accounting not only for smoking status but also for smoking exposure with measures, such as intensity, duration, or pack-years, is needed in studies of EC health effects to properly estimate their independent risk [39]. ...
E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.
... Administered in all 50 states by the U.S. Centers for Disease Control and Prevention as a household interview survey, the goal of the NHIS is to monitor a variety of diseases and health related concerns in the U.S., including tobacco use. 10 Because the NHIS is a de-identified database, IRB approval was not needed. ...
Introduction:
Combustible cigarette use is associated with an increased risk of several cardiovascular diseases; however, less is known about associations between these cardiovascular conditions and electronic cigarette use.
Methods:
This study investigated relationships between electronic and/or combustible cigarette use and diagnoses of cardiovascular diseases using the National Health Interview Survey from 2014, 2016, 2017, and 2018.
Results:
Compared to non-users, dual users of electronic and combustible cigarettes had increased likelihood of having prior diagnoses of hypertension (OR 1.660, 95% CI = 1.519-1.814), stroke (OR 2.396, 95% CI = 2.011-2.855), diabetes mellitus (OR 1.219, 95% CI = 1.108-1.341), coronary artery disease (OR 2.211, 95% CI = 1.837-2.660), and myocardial infarction (OR 3.839, 95% CI = 3.232-4.560). Exclusive use of electronic cigarettes was associated with an increased likelihood of having hypertension compared to non-users (OR 1.244, 95% CI = 1.048-1.477).
Conclusions:
There were no differences in diagnoses of stroke, diabetes mellitus, coronary artery disease, or myocardial infarction among exclusive electronic cigarette users compared to non-users; however, these associations could change as young electronic cigarette users with hypertension age, indicating the need for continued research.
... These results are interesting insofar as the factors associated with e-cigarettes use are for the most part also associated with tobacco use [38,39]. In addition, long-term health effects are probably not the same according the use of e-cigarette with or without tobacco smoking [40,41] with one recent study suggesting more negative health effects for dual use than cigarette smoking alone [42]. ...
Background
Electronic cigarette (e-cigarette) use has spread among adolescents in many countries, however users’ characteristics are not well known. We aimed to compare characteristics of exclusive e-cigarette users to those of exclusive tobacco users and dual users.
Methods
Data come from a representative sample of 11–19 years old students in Paris, surveyed each year between 2013 and 2017. Current e-cigarette and tobacco use were ascertained in the preceding 30 days. Data were analyzed using random intercept multinomial logistic regression models, exclusive tobacco smokers being the reference group.
Results
Among the 17,435 students included, 2.3% reported exclusive e-cigarette use, 7.9% exclusive tobacco use and 3.2% dual e-cigarette and tobacco use. Compared to exclusive tobacco smokers, e-cigarette users were: a) less likely to use cannabis (adjusted Odds-Ratio (aOR) = 0.15, 95% confidence interval (95% CI) = 0.09–0.25); b) more likely to initiate smoking with an e-cigarette or a hookah rather than traditional cigarettes (aOR = 2.91, 95% CI = 1.74–4.87 and aOR = 15.99, 95% CI = 8.62–29.67, respectively). Additionally, exclusive e-cigarette users are younger with an aOR = 0.29 (95% CI = 0.17–0.49) among 13–15 years and aOR = 0.11 (95% CI = 0.06–0.21) among > 17 years as compared to 11–13 years. The probability of being an exclusive e-cigarette user is lower among participants whose best friend smokes tobacco (aOR = 0.30, 95% CI = 0.20–0.44). Exclusive tobacco users and dual users have similar profiles.
Conclusions
Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products.
... The most serious difficulty for the second topic is that most vapers do not exclusively use E-cigarettes; instead, these individuals use one or more additional tobacco products (including traditional tobacco) (Borland et al., n.d.). Importantly, studies comparing the effects of E-cigarettes to combustible tobacco individuals have yielded mixed results: some articles studies are finding evidence of worsened cardiopulmonary outcomes in dual users than in those who use combustible tobacco alone (Wang et al. 2018;Mbbs et al. 2019), while others report no change in health risk between E-cigarettes and combustible tobacco use (Polosa et al. 2017;Mph et al. 2019). Standing on this point, our results shed some light in this aspect. ...
Electronic cigarettes (E-cigarettes) use is an emerging public health problem. Trying to assess the independent associations between E-cigarettes use and whole blood cell in a nationally representative sample of the US adults is very important for the smoking population. Using E-cigarettes data from NHANES (National Health and Nutrition Examination Survey) 2013-2018, 17,180 adults were included in this cross-sectional analysis. All participants were stratified into four different groups (non-smoke group N=10087, E-cigarettes group N=52, dual-smoke group N=249, cigarettes group N=6792) based on questions SMQ020 (smoked at least 100 cigarettes in life) and SMQ690H (used last 5 days E-cigarettes). Whole blood cell tests included white blood cell (WBC) with differentials, red blood cell (RBC) with characteristics, and platelet variables. With adjusted by age, gender, and race ethnicity, multivariate logistic regression analyses were used to assess independent associations between E-cigarettes group and other groups for different whole blood cell variables. A total of 17,180 participants were included in the study; 47.9% were males, with a mean age of 46.99 (±0.29). In WBC-related variables, non-smoke group had the lowest value in WBC counts (7.15±0.05), lymphocyte (2.15±0.02), and monocyte (0.57±0.01), among the four different groups. In RBC-related variables, non-smoke group had the lowest value in mean cell volume (MCV, 88.46±0.14, p<0.05) and mean cell hemoglobin (MCH, 29.73±0.06, p<0.05), among the four different groups. In adjusted analysis, WBC (OR = 0.97, 95% CI: 0.96-0.98, p<0.001), especially lymphocyte (OR = 0.97, 95% CI: 0.96-0.98, p<0.001) and monocyte (OR = 0.11, 95% CI: 0.02-0.66, p<0.001) of non-smoke group, showed negative significant effect for E-cigarettes group. Meanwhile, lower odds of MCV (OR = 0.91, 95% CI: 0.81-1.04, p<0.05) and MCH (OR = 0.81, 95% CI: 0.65-1.00, p<0.05) in non-smoke group were observed compared to E-cigarettes group. Conversely, for dual-smoke group and cigarette group, there was no significant results in all whole blood cell variables compared to E-cigarettes group. E-cigarettes use might be associated with a systemic response that could lead to an increase in WBC, especially lymphocytes and monocytes, in the US adults. Meanwhile, the properties of RBC might also be influenced simultaneously; MCV and MCH in E-cigarettes population were bigger than the non-smoke population.
... The use of e-cigs in ex-smokers was associated with a higher risk of stroke compared with never smokers although unexpected reduction in systolic blood pressure by 9-10 mmHg, and diastolic blood pressure by 6 mmHg were observed [141]. The daily e-cigarette consumption, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction [142], as well as significantly higher odds of cardiovascular disease among dual users of e-cigarettes and tobacco cigarettes compared with smoking alone [143]. Results from a recent cross-sectional study indicate that switching from combustible cigarettes to e-cigarettes does not confer stroke benefits. ...
Tobacco smoking remains without a doubt one of the leading causes of premature death worldwide. In combination with conventional protocols for smoking cessation, e-cigarettes have been proposed as a useful tool to quit smoking. Advertised as almost free of toxic effects, e-cigarettes have rapidly increased their popularity, becoming a sought-after device, especially among young people. Recently some health concerns about e-cigarette consumption are being raised. It is well known that they can release several toxic compounds, some of which are carcinogenic to humans, and emerging results are now outlining the risks related to the onset of respiratory and cardiovascular diseases and even cancer. The present review shows the emerging evidence about the role of technical components of the devices, the e-liquid composition as well as customization by consumers. The primary topics we discuss are the main toxicological aspects associated with e-cigarette consumption, focusing on the molecular pathways involved. Here it will be shown how exposure to e-cigarette aerosol induces stress/mitochondrial toxicity, DNA breaks/fragmentation following the same pathological pathways triggered by tobacco smoke, including the deregulation of molecular signalling axis associated with cancer progression and cell migration. Risk to fertility and pregnancy, as well as cardiovascular risk associated with e-cigarette use, have also been reported.
... It is common for patients to develop myocardial inflammation and even ischemia during lung infections (Morris, 2014;Feldman et al., 2019). Tobacco smoking is well known to increase cardiovascular diseases and worsen outcomes in the setting of pneumonia (Crotty Alexander et al., 2015a;Kondo et al., 2019) and recently, it has been suggested that dual use of e-cigarettes with conventional tobacco leads to significantly higher odds of cardiovascular disease compared with cigarette smoking alone (Osei et al., 2019). Thus, we assessed the impact of acute lung injury on inflammation in cardiac tissues of JUUL exposed mice. ...
While health effects of conventional tobacco are well defined, data on vaping devices, including one of the most popular e-cigarettes which have high nicotine levels, are less established. Prior acute e-cigarette studies have demonstrated inflammatory and cardiopulmonary physiology changes while chronic studies have demonstrated extra-pulmonary effects, including neurotransmitter alterations in reward pathways. In this study we investigated the impact of inhalation of aerosols produced from pod-based, flavored e-cigarettes (JUUL) aerosols three times daily for 3 months on inflammatory markers in the brain, lung, heart, and colon. JUUL aerosol exposure induced upregulation of cytokine and chemokine gene expression and increased HMGB1 and RAGE in the nucleus accumbens in the central nervous system. Inflammatory gene expression increased in the colon, while gene expression was more broadly altered by e-cigarette aerosol inhalation in the lung. Cardiopulmonary inflammatory responses to acute lung injury with lipopolysaccharide were exacerbated in the heart. Flavor-specific findings were detected across these studies. Our findings suggest that daily e-cigarette use may cause neuroinflammation, which may contribute to behavioral changes and mood disorders. In addition, e-cigarette use may cause gut inflammation, which has been tied to poor systemic health, and cardiac inflammation, which leads to cardiovascular disease.
... Additionally, larger studies have shown that the smokers who do not halt smoking often continue using both conventional cigarettes and e-cigarettes (dual users) (18). Compared with those who only smoke conventional cigarettes, dual users have a higher cardiovascular risk (201). ...
Electronic cigarettes or e-cigarettes are the most frequently used tobacco product among adolescents. Despite the widespread use of e-cigarettes and the known detrimental cardiac consequences of nicotine, the effects of e-cigarettes on the cardiovascular system are not well-known. Several in vitro and in vivo studies delineating the mechanisms of the impact of e-cigarettes on the cardiovascular system have been published. These include mechanisms associated with nicotine or other components of the aerosol or thermal degradation products of e-cigarettes. The increased hyperlipidemia, sympathetic dominance, endothelial dysfunction, DNA damage, and macrophage activation are prominent effects of e-cigarettes. Additionally, oxidative stress and inflammation are unifying mechanisms at many levels of the cardiovascular impairment induced by e-cigarette exposure. This review outlines the contribution of e-cigarettes in the development of cardiovascular diseases and their molecular underpinnings.
... 49 Long-term inhalation of NiO particles in mice has been found to cause oxidative stress and inflammation in the human lung and cardiac tissues. 50,51 As shown in Figure 1, it is evident that the metals contained in the EC aerosols are higher than the regulated limits (NIOSH and EMA) for Cr across all tested brands. It is worth mentioning that Cr(III), which is not carcinogenic, is the likely Cr form in aerosols containing Furthermore, in the samples where these metals were detected, their contents are below 0.5 and 0.1 ng/puff for Pb and Sn, respectively, which is considerably lower than the other major metal species. ...
... This single-center, three-arm study included 15 active smokers and 17 active e-cigarette users. A total of 39 measurements were performed, whereby the e-cigarette users were mostly tested in both the old and the new JUUL groups in order not to offer an entry into 'dual use' which seems to be a possible potentiation of health risks 28 . Participants were recruited from the population of the city of Munich by advertising and were assigned to the tobacco cigarette group or one of the two JUUL groups (old and new JUUL technology) according to the product that they normally used. ...
Introduction:
The rapid growth in the e-cigarette market after the launch of JUUL e-cigarettes led to much discussion on the potential benefits and risks of pods, JUUL devices, and conventional e-cigarettes compared with combustible cigarettes. Independent data are required to assess the effects of these products on cardiovascular surrogate parameters and cardiovascular risk.
Methods:
We conducted a single-center three-arm study comparing combustible cigarettes with JUUL e-cigarettes with the old and new technology. We recruited 32 participants who were active smokers (n=15) or vapers (n=17) and performed a total of 39 measurements before and 5, 15, and 30 minutes, after participants smoked a combustible cigarette or vaped a JUUL e-cigarette with the new or old technology. Measurements included peripheral and central blood pressures and parameters of arterial stiffness, including pulse wave velocity and augmentation index.
Results:
Peripheral systolic blood pressure, central blood pressure, and peripheral pulse rate increased significantly in all three groups (each p<0.05). Heart rate (HR) changes lasted significantly longer than blood pressure changes. The augmentation index and pulse wave velocity increased in all three groups, and a multivariate analysis of variance showed that the increases were independent of systolic blood pressure, sex, age, device, and HR.
Conclusions:
Changes in blood pressure and arterial stiffness are similar after cigarette smoking and JUUL use. These changes may be associated with an increased cardiovascular risk compared with no product use. However, a long-term follow-up evaluation of JUUL use and a head-to-head comparison with conventional e-cigarettes are still needed.
... Foi evidenciada a associação entre o uso diário de cigarro eletrônico e aumento do risco de infarto do miocárdio, que é cerca de 1,7 vezes maior em comparação com indivíduos que nunca usaram tal dispositivo (Alzahrani et al., 2018). Outro estudo relatou a associação de CE e CC como ainda mais perigosa para a ocorrência de DCV, com chances em torno de 36% maiores (Osei et al., 2019). ...
Introdução: O tabagismo é conhecido por trazer diversos malefícios, especialmente ao sistema cardiovascular. Os cigarros eletrônicos (CEs), por sua vez, foram criados como uma alternativa para a cessação tabágica, entretanto sua segurança e benefícios são duvidosos. Objetivo: Diante da crescente popularidade desses dispositivos, busca-se realizar uma revisão literária que vise identificar seus possíveis efeitos adversos ao sistema cardiovascular de jovens. Método: Foram feitas pesquisas em bancos de dados (Google acadêmico, BVS, SciELO, PubMed e EbscoHost) na tentativa de buscar estudos que correlacionem o uso de dispositivos eletrônicos para fumar (DEFs) por jovens e danos ao sistema cardiovascular. Resultados: Dentre os artigos revisados foi evidenciado que há presença de substâncias cardiotóxicas nos vapores dos CEs, que estão relacionadas com fenômenos que resultam em maior risco de doenças cardiovasculares, como aumento do estresse oxidativo, ativação plaquetária e variação da pressão arterial e frequência cardíaca. Ademais, observou-se um aumento exponencial do uso DEFs por adolescentes, uma maior chance de se tornar tabagista ao fazer uso desses dispositivos, bem como grandes chances de ocorrência de doenças cardiovasculares entre usuários duplos de CE e cigarro tradicional. Conclusão: Após a análise de 18 artigos, notou-se uma maior chance de desenvolver doenças cardiovasculares devido ao uso de CEs, o que é mais preocupante nos jovens, visto que se observa uma exposição precoce associada a maior chance de dependência. Portanto, considerando malefícios e as incertezas a respeito dos CEs, recomenda-se que jovens tomem cautela ao fazerem o uso desses dispositivos.
... Notably, most of these 113 studies focus on the health-related impacts of either smoking or vaping, but not both. [14][15][16][17][18] Finally, 114 much research remains inconclusive surrounding the harms associated with the dual use of 115 cigarettes and e-cigarettes, as well as with regards to how these impacts differ between 116 individuals who are solely users of either cigarettes or e-cigarettes. 12 117 The current analysis sought to use survey data to understand better the association between e-118 cigarette use and self-reported respiratory symptoms among youth, along with the association 119 between self-reported respiratory symptoms and e-cig dose (number of puffs per month), vaping 120 device, e-cigarette liquid flavour, and years vaped. ...
Introduction
E-cigarettes have been steadily increasing in popularity, both as cessation methods for smoking and for recreational and social reasons. This increase in vaping may pose cardiovascular and respiratory risks. We aimed to assess respiratory symptoms in youth users of e-cigarettes and cigarettes.
Methods
A cross-sectional survey design was utilized to assess Canadian youth aged 16-25 years old. Participants were recruited from the Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel November 2020 to March 2021. A total of 3,082 subjects completed the baseline survey. Of these, 2660 individuals who did not have asthma were included in the analysis. The exposure of interest was vaping dose, pack equivalent years, equivalent to cigarette pack years incorporating number of puffs per day, number of days vaped per month, and number of years vaped. Respiratory symptoms were measured using the five-item Canadian Lung Health Test. Poisson regression analyses were performed while adjusting for demographic confounders, stratified by smoking status. A non-stratified model tested the interaction of status and vaping dose and the effect of vaping device used was assessed among ever vapers. Analyses controlled for demographic characteristics, use of cannabis and alcohol, and survey date.
Results
Each additional puff year increased the rate ratio of respiratory symptoms by a factor of 11.36 (95%CI: 4.61-28.00; p<0.001) for never smokers, but among current daily smokers higher pack equivalent years were not associated with more respiratory symptoms (0.83; 95% CI: 0.23., 3.11). Among current vapers, those using pod-style devices were more likely to have more respiratory symptoms (1.25; 95% CI: 1.08, 1.45) after adjusting for dose.
Conclusions
Vaping is associated with an increased risk of reporting respiratory symptoms among never smoking youth and non-daily ever cigarette smokers. Use of e-cigarettes among non-smokers should be discouraged.
Funding
Canadian Institutes of Health Research
... Recent data suggest that in the past 30 days, adolescents and young adults (AYAs) most commonly used disposable devices, such as Puff Bar, while pod/cartridge-based e-cigarettes also remained popular [3][4][5]. E-cigarettes generally contain chemicals and constituents, including nicotine, solvents and flavors, that are associated with harms to the heart, lungs, and brain, as well as mental health [4,[6][7][8][9][10][11][12][13][14][15]. Nevertheless, in 2021, over 2 million U.S. middle and high school students reported using e-cigarettes in the past 30 days [4]. ...
Numerous studies have identified sociodemographic factors associated with susceptibility, ever-use and past-30-day use of e-cigarettes, including JUUL. However, it remains unknown which sociodemographic factors are associated with adolescents’ and young adults’ (AYA) use of the entire spectrum of different types of e-cigarette devices (e.g., disposables, pod/cartridge-based, and other e-cigarettes, like mods or tanks). The aim of this study was to examine the relationship between sociodemographic factors and use, future use intent and susceptibility to use different e-cigarette device types. We conducted a national online survey using a convenience sample of 13–24-year-olds, 50:50 e-cigarette ever- to never-users and sex and race/ethnicity balanced per the U.S. Census (n = 4351). Sociodemographic factors were not associated with ever use of disposables among AYAs or generally with intent to use e-cigarette devices in the future. However, sociodemographic factors were related to the use of pod/cartridge-based and other e-cigarette devices. LGBTQ+ AYAs were more likely to use pod/cartridge-based devices and to be susceptible to using all device types compared to other AYAs. Young adults, males, and other/multiracial non-Hispanic AYAs were more likely to report past-30-day-use of all devices and AA/Black non-Hispanic AYAs were more likely to report past-30-day use of pod/cartridge-based and other devices compared to former users. AA/Black non-Hispanic AYAs were more likely to be susceptible to using all devices and other/multiracial non-Hispanic AYAs were susceptible to using other devices (compared to White non-Hispanic AYAs). AYAs under 21 who were former users were more likely to intend using other devices in the future compared to AYAs 21 years or above. These findings may inform targeted prevention efforts to curb the growing popularity of different devices among AYAs.
... While reducing smoking frequency is associated with lower mortality risk, complete smoking cessation confers much greater benefit [59,60]. Moreover, there has been some concern that dual use might be associated with greater nicotine dependence, breathing difficulties, and cardiovascular disease risk compared to cigarette smoking alone [13,14,61]. Further study is needed to ascertain whether sustained dual users are delaying quitting completely and thereby increasing their duration of smoking, which research suggests may negate any potential benefit of reduced intensity of smoking [59,60,62,63]. ...
Background:
Little is known about the use of electronic nicotine delivery systems (ENDS) among low-income adult cigarette smokers, who experience severe tobacco-related health disparities.
Methods:
This study conducted interviews to examine experiences and perceptions associated with ENDS use among predominantly low-income adult smokers (n = 30; mean age 30.2 ± 12.9; 60% male, 46.7% African American, 30% white, 10% more than one race; 76.7% annual household income ≤USD 24,000). Interviews were transcribed verbatim and coded in NVivo 11.
Results:
Overall, participants reported complementing rather than substituting their smoking with ENDS use (e.g., using ENDS only when smoking is not allowed). Predominant reasons for vaping were convenience, smoking reduction/cessation, stress management, social acceptability, lower long-term costs than smoking, and appealing flavors. Common reasons for not switching to exclusive vaping were that ENDS did not satisfy cigarette cravings and concerns about ENDS health effects. Participants indicated higher likelihood of switching to exclusive ENDS use if the products were more affordable, perceived as substantially less harmful, tasted and felt more like smoking a cigarette, and more effective for reducing cravings.
Conclusions:
Continued research is needed to maximize any harm reduction potential of ENDS and ensure that these products do not contribute to worsening health disparities.
... Only two studies investigated the potential impact of the frequency/dose of EC use by DUs. A survey found that the risk of premature CVD was signi cantly higher in DUs with a daily use of ECs than in those with occasional use of ECs (23). Another survey found increased odds of COPD with increasing frequency of EC use among people who had never smoked, indicating a stepped harm of EC use (57). ...
Background: A high prevalence of dual use (DU) of e-cigarettes and conventional cigarettes has been reported across the world. In some countries most users of e-cigarettes are dual users (DUs). We wanted to investigate the health effects of DU and compare with the health effects of exclusive smoking of conventional cigarettes (ESCC).
Methods: A systematic search was carried out in PubMed, EMBASE, CINAHL, and Cochrane library. The last search was conducted on April 26, 2021. We included original articles on any topic relevant to health, in all languages. Reviewers independently assessed the main risks of bias without the use of automated tools. We followed the PRISMA guidelines. Both reviewers independently screened and read all publications.
Results: Fifty-five publications (52 studies) were included, 12 of the studies were prospective. There was great heterogeneity across studies both in methodology and outcome. Several studies, especially experimental studies with short-term outcome, found higher levels of harmful substances in ESCC than in DUs, however, the two largest population-based studies, with low risk of selection-bias, found higher levels of harmful substances in DUs than in ESCC. Most studies investigating symptoms or risk of disease were large population-based surveys. One study found that DUs reported a significantly better health than ESCC, while fifteen found a higher risk of e.g., pulmonary, cardiovascular or metabolic risk factors/symptoms, self-reported general health or cancer in DUs than in ESCC. The study with the longest follow-up, six years, found that DUs had an adjusted odds ratio of 1.48 (95% confidence interval 0.81–2.70) of a possibly smoking-related disease (confirmed by hospital discharge abstracts) compared with ESCC. Many methodological weaknesses were identified, such as risk of reverse causality. We found a correlation between high tobacco consumption in DUs and findings of negative health outcomes.
Conclusion: Due to many methodological weaknesses, it is difficult to draw any strong conclusions, but the results indicate that DU might be as or even more harmful than ESCC. Well-designed longitudinal studies are needed. Before recommending EC for smoking cessation health authorities should consider the high risk of DU and its potential consequences.
... 5 Observational studies have reported an association between e-cigarette use and various disease processes affecting different organ systems. [6][7][8][9][10] Due to a lack of long term data, the full spectrum of potential health consequences from e-cigarette use remains unknown. ...
Background
The popularity of electronic cigarette (e-cigarette) use continues to rise in the United States. While conventional cigarette smoking is an established risk factor for osteoporosis and osteoporotic fracture, the effects of e-cigarette use on bone health are unknown. We aimed to examine the association between e-cigarette use and fragility fractures.
Research Design and Methods
We pooled 2017–2018 data from the National Health and Nutrition Examination Survey (NHANES). We included men and women with complete information on key variables. E-cigarette use was categorized as either never or ever users. Ever users were further classified as former and current users. Fragility fracture was defined as a composite of self-reported fracture of the hip, spine or wrist which resulted from minimal trauma such as a fall from standing height or less.
Results
Of 5569 participants, there were 4519 (81.2%) never e-cigarette users, 1050 (18.8%) ever e-cigarette users, and 444 (8.0%) with self-reported fragility fracture. In adjusted models, ever e-cigarette users had a 46% higher prevalence of self-reported fragility fractures compared to never users (aPR: 1.46, 95% CI: 1.12, 1.89). We also observed a higher prevalence of fragility fractures among former and current e-cigarette users compared to never users (aPR: 1.89, 95% CI: 1.44, 2.48 and aPR: 1.77, 95% CI: 1.04, 3.02 respectively).
Conclusion
E-cigarette use was associated with a higher prevalence of self-reported fragility fracture. These findings suggest that e-cigarette use may be harmful to bone health. These data highlight the critical need for longitudinal studies exploring the potential effect(s) of e-cigarette use on bone health.
In October 2021, the US Food and Drug Administration (FDA) authorised marketing of RJ Reynolds Vapor Company's (RJR) Vuse Solo e-cigarette through FDA's Premarket Tobacco Product Application (PMTA) pathway. FDA concluded that RJR demonstrated Vuse products met the statutory standard of providing a net benefit to public health. A review of FDA's scientific justification reveals deficiencies: (1) not adequately considering Vuse's popularity with youth and evidence that e-cigarettes expanded the nicotine market and stimulate cigarette smoking; (2) trading youth addiction for unproven adult benefit without quantifying these risks and benefits; (3) not considering design factors that appeal to youth; (4) not addressing evidence that e-cigarettes used as consumer products do not help smokers quit and promote relapse in former smokers; (5) not discussing evidence that dual use is more dangerous than smoking; (6) narrowly focusing on the fact that e-cigarettes deliver lower levels of some toxicants without addressing direct evidence on adverse health effects; (7) downplaying significant evidence of other substantial harms; (8) not acting on FDA's own study showing no all-cause mortality benefit of reducing (but not stopping) cigarette use; and (9) improperly considering e-cigarettes' high abuse liability and potential for high youth addiction and undermining tobacco cessation. Because marketing these products is not appropriate for the protection of the public health, FDA should reconsider its Vuse marketing order as statutorily required and not use it as a template for other e-cigarette PMTAs. Policymakers outside the USA should anticipate that tobacco companies will use FDA's decision to try to weaken tobacco control regulation of e-cigarettes and promote their products.
This special communication provides a physicians' critique of the US Food and Drug Administration (FDA)'s decision to authorise the Vuse Solo (Vuse) Premarket Tobacco Application (PMTA). The PMTA authorisation represents the first time that FDA has authorised an Electronic Nicotine Delivery System (ENDS) for marketing in the USA. Using the FDA Decision Summary, the special communication identifies significant unanswered public health and scientific questions that prevent the authors from reaching FDA's conclusion that Vuse meets the Appropriate for the Protection of the Public Health (APPH) standard. The authors recommend FDA suspend the market authorisation and use these questions to re-evaluate the PMTA, and to prospectively monitor whether Vuse meets APPH standard. The special communication advances the ENDS harm reduction conversation because it calls for national tobacco regulators to develop an epidemiological prediction of ENDS impact on the population and to expand the scope of their analysis to evaluate the impacts of ENDS on congenital birth defects, abuse liability and non-flavour drivers of youth usage. Through learning from the American experience regulating Vuse, national tobacco regulators around the globe will be better equipped to evaluate the impact of ENDS on the public health.
Background:
The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
Methods:
The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.
Results:
Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
Conclusions:
The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Introduction
Electronic cigarettes (e-cigarettes) emerged in the U.S. market in the late 2000s. During 2017, e-cigarettes use among U.S. adults was 2.8%, with higher use among some population groups. Limited studies have assessed e-cigarette use among persons with diagnosed HIV (PWH). The purpose of this study is to describe national prevalence estimates of e-cigarette use among PWH by selected sociodemographic, behavioral, and clinical characteristics.
Methods
Data was collected between June 2018 and May 2019 as part of the Medical Monitoring Project, an annual cross-sectional survey that produces nationally representative estimates of behavioral and clinical characteristics of PWH in the U.S. Statistically significant differences (p<0.05) were determined using Chi-square tests. Data were analyzed in 2021.
Results
Among PWH, 5.9% reported currently using e-cigarettes, 27.1% had ever used them but were not using them currently, and 72.9% had never used them. Current use of e-cigarettes was highest among PWH who currently smoke conventional cigarettes (11.1%), PWH with major depression (10.8%), PWH aged 25-34 years (10.5%), PWH who reported injectable and non-injectable drug use in past 12 months (9.7%), PWH diagnosed less than five years ago (9.5%), self-reported sexual orientation as other (9.2%), and non-Hispanic white people (8.4%).
Conclusion
Overall, findings suggest that a greater proportion of PWH used e-cigarettes than the overall U.S. adult population and higher rates were observed among certain subgroups, including those who currently smoke cigarettes. E-cigarette use among PWH warrants continued attention because of its potential impact on HIV-related morbidity and mortality.
Introduction
Concurrent electronic nicotine delivery system (ENDS) and cigarette (dual) use is harmful. Identifying longitudinal trajectories of ENDS and cigarette use among dual users can help to determine the public health impact of ENDS and inform tobacco control policies and interventions.
Objectives
(1) To identify independent and joint trajectories of ENDS and cigarette use among wave (W) 1 adult dual users across W1 to W5 of the Population Assessment of Tobacco and Health (PATH) Study; and (2) identify W1 predictors of ENDS and cigarette joint trajectory group membership.
Methods
We used group-based trajectory modelling to estimate independent and joint trajectories of ENDS and cigarette use from wave 1 (W1; 2013–2014) to wave 5 (W5; 2018–2019) among W1 adult established dual users of ENDS and cigarettes (n=545) from the PATH Study. We used multinomial logistic regression to identify W1 predictors of joint trajectories.
Results
Two ENDS (early quitters=66.0%, stable users=34.0%) and three cigarette (stable users=55.2%, gradual quitters=27.3%, early quitters=17.5%) trajectories of W1 were identified. In joint trajectory analysis, 41.6% of participants were early ENDS quitters and stable cigarette users; 14.8% early ENDS quitters and gradual cigarette quitters; 14.6% stable ENDS users and stable cigarette users; 11.2% stable ENDS users and gradual cigarette quitters; 10.3% early ENDS quitters and early cigarette quitters; and 7.4% stable ENDS users and early cigarette quitters. Cigarette and ENDS use frequency, nicotine dependence, cannabis use and other non-combusted tobacco product use predicted trajectory group membership (p values <0.05).
Conclusions
Most dual users maintained long-term cigarette smoking or dual use, highlighting the need to address cessation of both products. Continued monitoring of trajectories and their predictors is needed, given ongoing changes to the ENDS marketplace.
Background
The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping.
Method
The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author.
Results
In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively.
Conclusions
Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.
Introduction
Stroke, as a common cerebrovascular disease, has a high mortality
and disability rate. Although many studies have reported that using e-cigarettes
was associated with occurrence of stroke, some studies have concluded that
e-cigarettes may help smokers stop using combustible cigarettes and reduce the
risk of stroke. Therefore, we aimed to validate the hypothesis that e-cigarette
use might be an independent risk factor for stroke occurrence by performing a
systematic review and meta-analysis of clinical epidemiology studies.
Methods
The pooled effect was calculated by the random effects model. I 2 was
used to test for heterogeneity. Sensitivity analysis was performed to evaluate the
stability of the overall results. Funnel plot symmetry or Egger’s regression was
used to evaluate publication bias. All p values were two-sided with significance
level at 0.05.
Results
Six cross-sectional studies with high quality were finally included in the
meta-analysis, which included a total of 1134896 participants. Analysis with
random effects model showed that the total pooled odds ratio (OR) of stroke
occurrence in e-cigarette users was 1.25 (95% CI: 1.01–1.55) (I 2 =96.6%,
p
Background:
The harmful vascular effects of smoking are well established, but the effects of chronic use of electronic cigarettes (e-cigarettes) on endothelial function are less understood. We hypothesized that e-cigarette use causes changes in blood milieu that impair endothelial function.
Methods:
Endothelial function was measured in chronic e-cigarette users, chronic cigarette smokers, and nonusers. We measured effects of participants' sera, or e-cigarette aerosol condensate, on NO and H2O2 release and cell permeability in cultured endothelial cells (ECs).
Results:
E-cigarette users and smokers had lower flow-mediated dilation (FMD) than nonusers. Sera from e-cigarette users and smokers reduced VEGF (vascular endothelial growth factor)-induced NO secretion by ECs relative to nonuser sera, without significant reduction in endothelial NO synthase mRNA or protein levels. E-cigarette user sera caused increased endothelial release of H2O2, and more permeability than nonuser sera. E-cigarette users and smokers exhibited changes in circulating biomarkers of inflammation, thrombosis, and cell adhesion relative to nonusers, but with distinct profiles. E-cigarette user sera had higher concentrations of the receptor for advanced glycation end products (RAGE) ligands S100A8 and HMGB1 (high mobility group box 1) than smoker and nonuser sera, and receptor for advanced glycation end product inhibition reduced permeability induced by e-cigarette user sera but did not affect NO production.
Conclusions:
Chronic vaping and smoking both impair FMD and cause changes in the blood that inhibit endothelial NO release. Vaping, but not smoking, causes changes in the blood that increase microvascular endothelial permeability and may have a vaping-specific effect on intracellular oxidative state. Our results suggest a role for RAGE in e-cigarette-induced changes in endothelial function.
The Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) 2018 position statement supports increased, regulated availability of e-cigarettes (ECs) as a harm-reduction measure and recommends further research into their use. Aligned with this recommendation, we aimed to critically evaluate the RANZCP’s stance on this issue through a literature review focused on the areas identified in the position statement as requiring further investigation: (1) the adverse health effects attributable to ECs; (2) use of ECs for smoking cessation (particularly for people living with severe mental illness); and (3) EC-associated risks for nicotine naïve young people. We identified and summarised evidence of harm attributable to ECs that is particularly relevant to young people through direct adverse health sequelae, onset of nicotine dependence and increased risk of combustible cigarette (CC) use. A small number of studies suggest ECs can be used for harm-reduction purposes in people diagnosed with nicotine dependence and severe mental illness. However, these results must be considered alongside robust evidence supporting the effectiveness of existing pharmacological interventions for smoking cessation in people with severe mental illness. The position statement is in urgent need of review in line with the available evidence.
The introduction of e-cigarettes, or electronic nicotine delivery systems (ENDS), has been accompanied by controversy regarding their safety and effectiveness as a cessation aid and by an explosion in their use by youth. Their use does not involve the combustion of tobacco and the creation of harmful combustion products; they have been seen as a “harm reduction” tool that may be of assistance in promoting smoking cessation. Recognition that ENDS can deliver an array of chemicals and materials with known adverse consequences has spurred more careful examination of these products. Nicotine, nitrosamines, carbonyl compounds, heavy metals, free radicals, reactive oxygen species, particulate matter, and “emerging chemicals of concern” are among the constituents of the heated chemical aerosol that is inhaled when ENDS are used. They raise concerns for cardiovascular and respiratory health that merit the attention of clinicians and regulatory agencies. Frequently cited concerns include evidence of disordered respiratory function, altered hemodynamics, endothelial dysfunction, vascular reactivity, and enhanced thrombogenesis. The absence of evidence of the consequences of their long-term use is of additional concern. Their effectiveness as cessation aids and beneficial impact on health outcomes continue to be examined. It is important to ensure that their production and availability are thoughtfully regulated to optimise their safety and permit their use as harm reduction devices and potentially as smoking-cessation aids. It is equally vital to effectively prevent them from becoming ubiquitous consumer products with the potential to rapidly induce nicotine addiction among large numbers of youth. Clinicians should understand the nature of these products and the implications of their use.
Objectives
This umbrella review aims to summarise the evidence about electronic nicotine delivery systems’ (ENDS) risk and safety health profile to inform ENDS health communication strategies.
Data sources and study selection
Six databases were searched for systematic reviews presenting evidence on ENDS-related health effects. Ninety reviews divided into five categories were included: toxicity=20, health effects=40, role in smoking cessation=24, role in transition to combustible cigarettes (CCs)=13 and industry marketing claims=4.
Data extraction
Findings were synthesised in narrative summaries. Meta-analyses were conducted by study type when appropriate. Quality assessment was conducted using the Measurement Tool to Assess Systematic Reviews. The Institute of Medicine’s Levels of Evidence Framework was used to classify the evidence into high-level, moderate, limited-suggestive and limited-not-conclusive.
Data synthesis
We found high-level evidence that ENDS exposes users to toxic substances; increases the risk of respiratory disease; leads to nicotine dependence; causes serious injuries due to explosion or poisoning; increases smoking cessation in clinical trials but not in observational studies; increases CC initiation; and exposure to ENDS marketing increases its use/intention to use. Evidence was moderate for ENDS association with mental health and substance use, limited-suggestive for cardiovascular, and limited-not-conclusive for cancer, ear, ocular and oral diseases, and pregnancy outcomes.
Conclusions
As evidence is accumulating, ENDS communication can focus on high-level evidence on ENDS association with toxicity, nicotine addiction, respiratory disease, ENDS-specific harm (explosion, poisoning) and anti-ENDS industry sentiment. Direct comparison between the harm of CCs and ENDS should be avoided.
PROSPERO registration number
CRD42021241630.
Background
With widespread awareness about the harmful effects of traditional smoking, many people are considering using an e-cigarette. However, many studies have shown that e-cigarettes are not entirely harmless, and their use has been implicated in causing major adverse cardiovascular events.
Methods
We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to conduct this systematic review. An electronic search was conducted comprehensively through five databases to find the relevant articles. The odds ratio (OR) was used for comparing groups. Meta-analysis was conducted using R statistical software version 3.4.3. A random-effect model was used.
Results
A total of 4 studies were included in the analysis incorporating data on 585,306 individuals. Of these, 19,435 were e-cigarettes users, while 1693 used only traditional cigarette users, and 553,095 were non-e-cigarette users. 7.0% of e-cigarettes users suffered an MI (myocardial infarction), while 7.7% and 6.5% of traditional smoking and non-e-cigarettes users suffered an MI. The OR of getting an MI in e-cigarettes (e-cigarettes only or e-cigarettes + traditional smoking) users was 1.33 (95% CI = 1.14–1.56, p-value = 0.01) in comparison to non e-cigarette users (traditional smoking or no smoking). While it is 0.61 (95% CI = 0.40–0.93, p-value 0.02) when compared with traditional smoking.
Conclusion
Those using e-cigarettes have higher odds of suffering from an MI in comparison to not using e-cigarettes. However, using e-cigarettes is associated with half risk of the risk of MI in comparison to traditional smoking.
Background
E-cigarette prevention education aims to mitigate adolescent e-cigarette use. Such education is increasingly delivered through virtual/video-based teaching platforms (e.g. Zoom, Google Classrooms). However, there is little evidence about the effectiveness of virtual e-cigarette education compared to in-person education on adolescents’ knowledge about e-cigarettes, perceived addictiveness and intent to try e-cigarettes, cigarettes, and marijuana.
Objective
To evaluate the effectiveness of virtual e-cigarette education compared to in-person education on student knowledge and perceived addictiveness of e-cigarettes and intent to try e-cigarettes.
Design, Setting and Method
We conducted a pre- and post-education evaluation among 10 middle and high school students in the Greater Birmingham area, Alabama, who were non-randomly assigned to receive either virtual ( n = 745) or in-person e-cigarette education ( n = 286) (mean age: 14.36 years). The study used a 25-minute educational presentation about the health effects of e-cigarettes, the risks of second- and third-hand smoke, the addictive nature of nicotine, and marketing strategies of e-cigarette companies. Participants completed a 10-minute self-administered survey immediately before and after the presentation.
Results and conclusion
Except for certain e-cigarette knowledge-related items, our study shows that both virtual and in-person education had similar effects on improving knowledge about e-cigarettes, increasing perceived addictiveness and reducing intent to try e-cigarettes, cigarettes and marijuana among participants. Virtual education may be applied where in-person education is not feasible (e.g. in rural communities).
Background
Nowadays, cigarette smoking remains the leading cause of chronic disease and premature death, especially cardiovascular disease. As an emerging tobacco product, e-cigarettes have been advocated as alternatives to canonical cigarettes, and thus may be an aid to promote smoking cessation. However, recent studies indicated that e-cigarettes should not be completely harmless to the cardiovascular system.
Aim of Review
This review aimed to build up an integral perspective of cigarettes and e-cigarettes-related cardiovascular toxicity.
Key Scientific Concepts of Review
This review adopted the adverse outcome pathway (AOP) framework as a pivotal tool and aimed to elucidate the association between the molecular initiating events (MIEs) induced by cigarette and e-cigarette exposure to the cardiovascular adverse outcome. Since the excessive generation of reactive oxygen species (ROS) has been widely approved to play a critical role in cigarette smoke-related CVD and may also be involved in e-cigarette-induced toxic effects, the ROS overproduction and subsequent oxidative stress are regarded as essential parts of this framework. As far as we know, this should be the first AOP framework focusing on cigarette and e-cigarette-related cardiovascular toxicity, and we hope our work to be a guide in exploring the biomarkers and novel therapies for cardiovascular injury.
Aim: The prevalence of the use of electronic cigarettes (e-cigarettes) has grown rapidly in the past decade in the United States. While numerous studies have demonstrated combustible cigarette is closely associated with an increased risk of arthritis diseases, little is known about the effect of e-cigarette usage on inflammatory arthritis diseases. We aimed to determinate if e-cigarette usage is associated with an increased risk of inflammatory arthritis.
Methods: Data were obtained from the Behavioral Risk Factor Surveillance System, which is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 924,882 participants with information on e-cigarette usage and inflammatory arthritis were included. We used multivariable logistic regression to estimate the risk of arthritis associated with e-cigarette usage.
Results: Of the 924,882 participants, there were 30,569 (3.3%) current e-cigarette users, and 314,190 (25.9%) reported to have inflammatory arthritis diseases. In the fully adjusted model, we observed that the odds ratio (OR) (95% confidence interval) of inflammatory arthritis diseases was 1.81 (95% CI, 1.70-1.93) for current e-cigarette users compared with never e-cigarette users. The ORs of inflammatory arthritis diseases were 1.31 (95% CI, 1.18-1.47), and 1.55 (95% CI, 1.42-1.69) among sole e-cigarette and dual users compared with never e-cigarette users, respectively.
Conclusions: This is the first study to observe a cross-sectional association between e-cigarette usage and inflammatory arthritis diseases, and the findings were consistent in both sole-e-cigarette users and dual users. Our findings provide evidence that e-cigarette usage might be an important risk factor for arthritis diseases, which may have regulatory implications for e-cigarette control.
Purpose
: To determine the association between cigarette use (i.e., never-use – reference group, exclusive e-cigarette users, exclusive cigarette smoking, and dual use of both products) with cardiometabolic risk biomarkers.
Methods
: Data came from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey. We used weighted logistic regression models to determine the association of cigarette use and reduced high-density lipoprotein cholesterol (HDL-C; <40 mg/dL, for men and <50 mg/dL for women), elevated low-density lipoprotein cholesterol (LDL-C; ≥130 mg/dL), elevated triglycerides (TG; ≥150 mg/dL), elevated fasting blood glucose (FBG; (≥100 mg/dL), and high blood pressure (HBP; Systolic ≥130 mm Hg/Diastolic ≥85 mm Hg).
Results
: Of the 8,688 adults 18+ years of age included, 2.7%, 3.2% and 14.9% self-reported exclusive e-cigarette, dual use, and exclusive cigarette smoking respectively. After adjusting for covariates, exclusive e-cigarette use was significantly associated with increased odds of HBP (adjusted odds ratio (aOR)=2.05, 95% confidence interval (CI)=1.03, 4.08). Dual use was associated with increased odds of reduced HDL-C (aOR= 1.64, 95% (CI): =1.01, 2.70). Exclusive cigarette smoking was significantly associated with reduced HDL-C (aOR=1.80, 95% (CI)=1.45, 2.23) and elevated TG (aOR=1.59, 95% (CI)=1.01, 2.52).
Conclusions
: Results are preliminary and warrant replication from larger samples with longitudinal follow-up.
Background:
The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
Methods:
The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.
Results:
Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
Conclusions:
The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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-cigarettes and its use in smoking cessation and as harm reduction
Objective
To describe the sociodemographic characteristics associated with e-cigarette ever use and to examine the impact of e-cigarette ever use on lung function impairment in an ageing population.
Design
A cross-sectional analysis of data from the Canadian Longitudinal Study on Aging.
Setting
A national stratified sample of 44 817 adults living in Canadian provinces.
Participants
Respondents included participants aged 45–85 and residing in the community in Canadian provinces.
Outcome measures
The Global Lung Function Initiative normative values for forced expiratory volume in the first second (FEV 1 ), forced vital capacity (FVC), forced expiratory ratio (FEV 1 /FVC) appropriate for age, sex, height and ethnicity were used to interpret the severity of lung function impairment. Multinomial logistic regression analysis was used to examine the impact of e-cigarette ever use on obstructive and restrictive lung function impairment.
Results
The prevalence of e-cigarette ever use was 6.5% and varied by sociodemographic factors including higher prevalence among individuals younger than 65 years, those with lower education attainment and those with lower annual household income. E-cigarette ever use was associated with 2.10 (95% CI 1.57 to 2.08) times higher odds of obstructive lung function impairment after adjusting for conventional cigarette smoking and other covariates. Individuals with exposure to e-cigarette ever use and 15 or more pack-years had 7.43 (95% CI 5.30 to 10.38) times higher odds for obstructive lung function impairment when compared with non-smokers and non-e-cigarette users after adjusting for covariates. Smokers with 15 or more pack-years had higher odds of restrictive lung function impairment irrespective of e-cigarette ever use.
Conclusions
Ever use of e-cigarettes was found to be associated with obstructive lung function impairment after adjusting for covariates, suggesting that e-cigarette use may be adding to the respiratory and other chronic disease burden in the population.
Introduction
Limited research exists about the possible cardiovascular effects of electronic nicotine delivery devices (ENDS). We therefore sought to compare exposure to known or potentially cardio-toxic volatile organic compounds (VOCs) in ENDS users, smokers, and dual users.
Methods
371 individuals from the Cardiovascular Injury due to Tobacco Use study, a cross-sectional study of healthy participants aged 21-45 years were categorized as non-users of tobacco (n=87), sole ENDS users (n=17), cigarette smokers (n=237) and dual users (n=30) based on 30-day self-reported tobacco product use patterns. Participants provided urine samples for VOC and nicotine metabolite measurement. We assessed associations between tobacco product use and VOC metabolite measures using multivariable-adjusted linear regression models.
Results
Mean [SD] age of the population was 32 [±6.8] years, 55% men. Mean urinary cotinine levels in non-users of tobacco was 2.6ng/mg creatinine, while cotinine levels were similar across all tobacco product use categories (851.6 – 910.9ng/mg creatinine). In multivariable-adjusted models, sole ENDS users had higher levels of metabolites of acrolein, acrylamide, acrylonitrile, and xylene compared with non-users of tobacco, but lower levels of most VOC metabolites compared with cigarette smokers or dual users. In direct comparison of cigarettes smokers and dual users, we found lower levels of metabolites of styrene and xylene in dual users.
Conclusion
While sole ENDs use may be associated with lower VOC exposure compared to cigarette smoking, further study is required to determine the potential health effects of the higher levels of certain reactive aldehydes, including acrolein, in ENDS users compared with non-users of tobacco.
Implications
ENDS use in conjunction with other tobacco products may not significantly reduce exposure to VOC, but sole use does generally reduce some VOC exposure and warrants more in-depth studies.
Background
Heated tobacco products (also called ‘heat-not-burn’ products) heat tobacco at temperatures below that of combustion, causing nicotine and other compounds to aerosolise. One such product, IQOS from Philip Morris International, is being marketed internationally with claims of harm reduction. We sought to determine whether exposure to IQOS aerosol impairs arterial flow-mediated dilation (FMD), a measure of vascular endothelial function that is impaired by tobacco smoke.
Methods
We exposed anaesthetised rats (n=8/group) via nose cone to IQOS aerosol from single HeatSticks, mainstream smoke from single Marlboro Red cigarettes or clean air for a series of consecutive 30 s cycles over 1.5–5 min. Each cycle consisted of 15 or 5 s of exposure followed by removal from the nose cone. We measured pre-exposure and postexposure FMD, and postexposure serum nicotine and cotinine.
Results
FMD was impaired comparably by ten 15 s exposures and ten 5 s exposures to IQOS aerosol and to cigarette smoke, but not by clean air. Serum nicotine levels were similar to plasma levels after humans have smoked one cigarette, confirming that exposure conditions had real-world relevance. Postexposure nicotine levels were ~4.5-fold higher in rats exposed to IQOS than to cigarettes, despite nicotine being measured in the IQOS aerosol at ~63% the amount measured in smoke. When IQOS exposure was briefer, leading to comparable serum nicotine levels to the cigarette group, FMD was still comparably impaired.
Conclusions
Acute exposures to IQOS aerosol impairs FMD in rats. IQOS use does not necessarily avoid the adverse cardiovascular effects of smoking cigarettes.
Background
Health effects of electronic cigarette (EC) use in patients with chronic obstructive pulmonary disease (COPD) are largely unexplored.
Aim
We present findings from a long-term prospective assessment of respiratory parameters in a cohort of COPD patients who ceased or substantially reduced conventional cigarette use with ECs.
Methods
We prospectively re-evaluated COPD exacerbations, spirometric indices, subjective assessments (using the COPD Assessment Tool [CAT] scores), physical activity (measured by the 6-minute walk distance [6MWD]), and conventional cigarette use in EC users with COPD who were retrospectively assessed previously. Baseline measurements prior to switching to EC use were compared to follow-up visits at 12, 24, and 36 months. Age- and sex-matched regularly smoking COPD patients who were not using ECs were included as reference (control) group.
Results
Complete data were available from 44 patients. Compared to baseline in the EC-user group, there was a marked decline in the use of conventional cigarettes. Although there was no change in lung function, significant improvements in COPD exacerbation rates, CAT scores, and 6MWD were observed consistently in the EC user group over the 3-year period (p<0.01). Similar findings were noted in COPD EC users who also smoked conventional cigarettes (“dual users”).
Conclusion
The present study suggests that EC use may ameliorate objective and subjective COPD outcomes and that the benefits gained may persist long-term. EC use may reverse some of the harm resulting from tobacco smoking in COPD patients.
Introduction
Electronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional cigarettes and have grown in popularity. Experimental and clinical evidence suggests that they could increase the risk of myocardial infarction.
Methods
The National Health Interview Surveys of 2014 (n=36,697) and 2016 (n=33,028) were used to examine the cross-sectional association between e-cigarette use (never, former, some days, daily) and cigarette smoking (same categories) and myocardial infarction in a single logistic regression model that also included demographics (age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia) using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017 and 2018.
Results
Daily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p<0.001). Former and some day e-cigarette use were not significantly associated with having had a myocardial infarction (p=0.608 and p=0.392) whereas former (OR=1.70, p<0.001) and some day cigarette smoking (OR=2.36, p<0.001) were. Odds of a myocardial infarction were also increased with history of hypertension (OR=2.32, p<0.001); high cholesterol (OR=2.36, p<0.001); and diabetes (OR=1.77, p<0.001); and age (OR=1.65 per 10 years, p<0.001). Women (OR=0.47, p<0.001) had lower odds of myocardial infarction.
Conclusions
Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.
Heat-not-burn tobacco products, battery powered devices that heat leaf tobacco to approximately 500 degrees Fahrenheit to produce an inhalable aerosol, are being introduced in markets around the world. Japan, where manufacturers have marketed several heat-not-burn brands since 2014, has been the focal national test market, with the intention of developing global marketing strategies. We used Google search query data to estimate, for the first time, the scale and growth potential of heat-not-burn tobacco products. Average monthly searches for heat-not-burn products rose 1,426% (95%CI: 746,3574) between their first (2015) and second (2016) complete years on the market and an additional 100% (95%CI: 60, 173) between the products second (2016) and third years on the market (Jan-Sep 2017). There are now between 5.9 and 7.5 million heat-not-burn related Google searches in Japan each month based on September 2017 estimates. Moreover, forecasts relying on the historical trends suggest heat-not-burn searches will increase an additional 32% (95%CI: -4 to 79) during 2018, compared to current estimates for 2017 (Jan-Sep), with continued growth thereafter expected. Contrasting heat-not-burn’s rise in Japan to electronic cigarettes’ rise in the United States we find searches for heat-not-burn eclipsed electronic cigarette searches during April 2016. Moreover, the change in average monthly queries for heat-not-burn in Japan between 2015 and 2017 was 399 (95% CI: 184, 1490) times larger than the change in average monthly queries for electronic cigarettes in the Unites States over the same time period, increasing by 2,956% (95% CI: 1729, 7304) compared to only 7% (95% CI: 3,13). Our findings are a clarion call for tobacco control leaders to ready themselves as heat-not-burn tobacco products will likely garner substantial interest as they are introduced into new markets. Public health practitioners should expand heat-not-burn tobacco product surveillance, adjust existing tobacco control strategies to account for heat-not-burn tobacco products, and preemptively study the health risks/benefits, popular perceptions, and health messaging around heat-not-burn tobacco products.
Background
Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States.
Methods
We present prevalence estimates for 12 types of tobacco products, using data from 45,971 adult and youth participants (≥12 years of age) from Wave 1 (September 2013 through December 2014) of the Population Assessment of Tobacco and Health (PATH) Study, a large, nationally representative, longitudinal study of tobacco use and health in the United States. Participants were asked about their use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe tobacco, hookah, snus pouches, other smokeless tobacco, dissolvable tobacco, bidis, and kreteks. Estimates of the prevalence of use for each product were determined according to use category (e.g., current use or use in the previous 30 days) and demographic subgroup, and the prevalence of multiple-product use was explored.
Results
More than a quarter (27.6%) of adults were current users of at least one type of tobacco product in 2013 and 2014, although the prevalence varied depending on use category. A total of 8.9% of youths had used a tobacco product in the previous 30 days; 1.6% of youths were daily users. Approximately 40% of tobacco users, adults and youths alike, used multiple tobacco products; cigarettes plus e-cigarettes was the most common combination. Young adults (18 to 24 years of age), male adults and youths, members of racial minorities, and members of sexual minorities generally had higher use of tobacco than their counterparts.
Conclusions
During this study, 28% of U.S. adults were current users of tobacco, and 9% of youths had used tobacco in the previous 30 days. Use of multiple products was common among tobacco users. These findings will serve as baseline data to examine between-person differences and within-person changes over time in the use of tobacco products. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration.)
Exposure to cigarette smoke is known to result in impaired host defense responses and immune suppressive effects. However, the effects of new and emerging tobacco products, such as e-cigarettes, on the immune status of the respiratory epithelium are largely unknown. We conducted a clinical study collecting superficial nasal scrape biopsies, nasal lavage, urine, and serum from non-smokers, cigarette smokers and e-cigarette users and assessed them for changes in immune gene expression profiles. Smoking status was determined based on a smoking history and a 3-4 week smoking diary and confirmed using serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels. Total RNA from nasal scrape biopsies were analyzed using the nCounter® Human Immunology v2 Expression panel. Smoking cigarettes or vaping e-cigarettes resulted in decreased expression of immune-related genes. All genes with decreased expression in cigarette smokers (n=53) were also decreased in e-cigarette smokers. Additionally, vaping e-cigarettes was associated with suppression of in a large number of unique genes (n=305). Furthermore, the e-cigarette users showed a greater suppression of genes common with those changed in cigarette smokers. This was particularly apparent for suppressed expression of transcription factors, such as EGR1, which was functionally associated with decreased expression of 5 target genes in cigarette smokers and 18 target genes in e-cigarette users. Taken together, these data indicate that vaping e-cigarettes is associated with decreased expression of a large number of immune-related genes, which are consistent with immune suppression at the level of the nasal mucosa.
Cardiovascular disease is the major cause of death in smokers. Although new tobacco products such as e-cigarettes do not generate many of the harmful or potentially harmful constituents (HPHCs), present in combustible tobacco products the cardiovascular effects of these devices are unknown and their efficacy in promoting and sustaining cessation remains unclear. Currently, these devices are being marketed as cleaner and safer alternative to smoking that could help smokers quit smoking. Nevertheless, e-cigarette aerosols contain appreciable levels of carbonyls, which within the concentration range reported in e-cigarettes, exert significant cardiovascular toxicity. Moreover, even by itself, nicotine is a sympathomimetic drug that elicits hemodynamic and metabolic changes that could increase the risk of acute cardiovascular events such as arrhythmias or plaque rupture and chronically increase cardiovascular disease risk by inducing dyslipidemia. The dose-response relationship between smoking and cardiovascular mortality is non-linear, suggesting that reduction in HPHC concentrations in e-cigarette aerosols may not result in proportional harm reduction and decreased HPHC exposure may be offset by increased use by individuals who believe that e-cigarettes are safer than conventional cigarettes. Thus, taken together, current evidence does not entirely support the notion that e-cigarettes are reduced harm products or effective smoking cessation devices.
Electronic (e)-cigarette use is rapidly rising, with 20 % of Americans ages 25–44 now using these drug delivery devices. E-cigarette users expose their airways, cells of host defense, and colonizing bacteria to e-cigarette vapor (EV). Here, we report that exposure of human epithelial cells at the air–liquid interface to fresh EV (vaped from an e-cigarette device) resulted in dose-dependent cell death. After exposure to EV, cells of host defense—epithelial cells, alveolar macrophages, and neutrophils—had reduced antimicrobial activity against Staphylococcus aureus (SA). Mouse inhalation of EV for 1 h daily for 4 weeks led to alterations in inflammatory markers within the airways and elevation of an acute phase reactant in serum. Upon exposure to e-cigarette vapor extract (EVE), airway colonizer SA had increased biofilm formation, adherence and invasion of epithelial cells, resistance to human antimicrobial peptide LL-37, and up-regulation of virulence genes. EVE-exposed SA were more virulent in a mouse model of pneumonia. These data suggest that e-cigarettes may be toxic to airway cells, suppress host defenses, and promote inflammation over time, while also promoting virulence of colonizing bacteria.
Key message
Acute exposure to e-cigarette vapor (EV) is cytotoxic to airway cells in vitro.
Acute exposure to EV decreases macrophage and neutrophil antimicrobial function.
Inhalation of EV alters immunomodulating cytokines in the airways of mice.
Inhalation of EV leads to increased markers of inflammation in BAL and serum.
Staphylococcus aureus become more virulent when exposed to EV.
Background
E-cigarettes are currently being debated regarding their possible role in smoking cessation and as they are becoming increasingly popular, the research to date requires investigation.
Objectives
To investigate whether the use of e-cigarettes is associated with smoking cessation or reduction, and whether there is any difference in efficacy of e-cigarettes with and without nicotine on smoking cessation.
Data Sources
A systematic review of articles with no limit on publication date was conducted by searching PubMed, Web of Knowledge and Scopus databases.
Methods
Published studies, those reported smoking abstinence or reduction in cigarette consumption after the use of e-cigarettes, were included. Studies were systematically reviewed, and meta-analyses were conducted using Mantel-Haenszel fixed-effect and random-effects models. Degree of heterogeneity among studies and quality of the selected studies were evaluated.
Results
Six studies were included involving 7,551 participants. Meta-analyses included 1,242 participants who had complete data on smoking cessation. Nicotine filled e-cigarettes were more effective for cessation than those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Amongst 1,242 smokers, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled Effect Size of 0.20 (95%CI 0.11-0.28). Use of e-cigarettes was also associated with a reduction in the number of cigarettes used.
Limitations
Included studies were heterogeneous, due to different study designs and gender variation. Whilst we were able to comment on the efficacy of nicotine vs. non-nicotine e-cigarettes for smoking cessation, we were unable to comment on the efficacy of e-cigarettes vs. other interventions for cessation, given the lack of comparator groups in the studies included in this meta-analysis.
Conclusions
Use of e-cigarettes is associated with smoking cessation and reduction. More randomised controlled trials are needed to assess effectiveness against other cessation methods.
Background
E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments.
Methods
We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms.
Results
A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
Conclusions
E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608.)
Background:
Contemporary data on the prevalence of e-cigarette use in the United States are limited.
Objective:
To report the prevalence and distribution of current e-cigarette use among U.S. adults in 2016.
Design:
Cross-sectional.
Setting:
Behavioral Risk Factor Surveillance System, 2016.
Participants:
Adults aged 18 years and older.
Measurements:
Prevalence of current e-cigarette use by sociodemographic groups, comorbid medical conditions, and states of residence.
Results:
Of participants with information on e-cigarette use (n = 466 842), 15 240 were current e-cigarette users, representing a prevalence of 4.5%, which corresponds to 10.8 million adult e-cigarette users in the United States. Of the e-cigarette users, 15% were never-cigarette smokers. The prevalence of current e-cigarette use was highest among persons aged 18 to 24 years (9.2% [95% CI, 8.6% to 9.8%]), translating to approximately 2.8 million users in this age range. More than half the current e-cigarette users (51.2%) were younger than 35 years. In addition, the age-standardized prevalence of e-cigarette use was high among men; lesbian, gay, bisexual, and transgender (LGBT) persons; current combustible cigarette smokers; and those with chronic health conditions. The prevalence of e-cigarette use varied widely among states, with estimates ranging from 3.1% (CI, 2.3% to 4.1%) in South Dakota to 7.0% (CI, 6.0% to 8.2%) in Oklahoma.
Limitation:
Data were self-reported, and no biochemical confirmation of tobacco use was available.
Conclusion:
E-cigarette use is common, especially in younger adults, LGBT persons, current cigarette smokers, and persons with comorbid conditions. The prevalence of use differs across states. These contemporary estimates may inform researchers, health care policymakers, and tobacco regulators about demographic and geographic distributions of e-cigarette use.
Primary funding source:
American Heart Association Tobacco Regulation and Addiction Center, which is funded by the U.S. Food and Drug Administration and National Heart, Lung, and Blood Institute.
Electronic cigarettes (E-cigarettes) have become popular as substitutes for conventional tobacco cigarettes or to aid quitting, but little is known about the potential risks to cardiovascular health for smokers and nonsmokers. We sought to compare the impact of E-cigarettes with conventional cigarettes on platelet function in healthy adult smokers and nonsmokers. A crossover single-blind study in 40 healthy participants (20 smokers, 20 nonsmokers, matched for age and sex) was conducted. Each participant smoked a conventional cigarette then returned 1 week later to vape a study E-cigarette with the same nominal nicotine content. Blood samples were drawn shortly before and 5 minutes after each episode and analyzed for platelet aggregation, soluble CD40-ligand (sCD40L) and soluble P-selectin (sP-selectin). At baseline, smokers had significantly higher levels of sCD40L and sP-selectin (all p ≤0.01) than nonsmokers. Within 5 minutes of using either a conventional cigarette or E-cigarette, changes in the levels of sCD40L, sP-selectin, and platelet aggregation (all p ≤0.01) were detectable in both smokers and nonsmokers. In smokers, there were no significant changes in sCD40L and sP-selectin but there was a significant increase in platelet aggregation. In nonsmokers, there was a significant increase in all markers of platelet activation following both cigarette and E-cigarette use. Both traditional and E-cigarettes have short-term effects on platelet activation, although in nonsmokers the use of E-cigarettes had a less important impact. In conclusion, we provide the first comparison data of the acute impact of Tobacco-cigarette and E-cigarette smoking on the platelet function in smokers and nonsmokers.
The National Academies of Sciences, Engineering, and Medicine (NASEM) Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems released a consensus report, Public Health Consequences of e-Cigarettes,¹ in January. The report is a comprehensive review of the health effects of electronic cigarette (e-cigarette) use.
In the past 2 decades, a high prevalence of risk factors for cardiovascular disease, such as obesity, physical inactivity, and poor diet, has been observed among young individuals living in developed countries. The rate of substance abuse (opioids, cocaine, electronic cigarettes, and anabolic steroids) is also increasing among young adults, whereas cigarette smoking might be declining. Among younger individuals (aged 18–50 years), the incidence of cardiovascular diseases over the same time period has either been steady or has increased, in contrast to the trend towards a lower incidence of cardiovascular disease in adults aged >50 years. Current observations might, therefore, be used to forecast a potential epidemic of cardiovascular disease in the near future as the younger segment of the population ages. In this Review, we discuss the burden of risk factors for ischaemic heart disease, heart failure, atrial fibrillation, and sudden cardiac death among young adults aged 18–45 years. Furthermore, we discuss the prevalence, incidence, and temporal trends of various cardiovascular diseases among this young segment of the population.
Importance:
Electronic cigarettes (e-cigarettes) have gained unprecedented popularity, but virtually nothing is known about their cardiovascular risks.
Objective:
To test the hypothesis that an imbalance of cardiac autonomic tone and increased systemic oxidative stress and inflammation are detectable in otherwise healthy humans who habitually use e-cigarettes.
Design, setting, and participants:
Cross-sectional case-control study of habitual e-cigarette users and nonuser control individuals from 2015 to 2016 at the University of California, Los Angeles. Otherwise healthy habitual e-cigarette users between the ages of 21 and 45 years meeting study criteria, including no current tobacco cigarette smoking and no known health problems or prescription medications, were eligible for enrollment. Healthy volunteers meeting these inclusion criteria who were not e-cigarette users were eligible to be enrolled as control individuals. A total of 42 participants meeting these criteria were enrolled in the study including 23 self-identified habitual e-cigarette users and 19 self-identified non-tobacco cigarette, non-e-cigarette user control participants.
Main outcomes and measures:
Heart rate variability components were analyzed for the high-frequency component (0.15-0.4 Hz), an indicator of vagal activity, the low-frequency component (0.04-0.15 Hz), a mixture of both vagal and sympathetic activity, and the ratio of the low frequency to high frequency, reflecting the cardiac sympathovagal balance. Three parameters of oxidative stress were measured in plasma: (1) low-density lipoprotein oxidizability, (2) high-density lipoprotein antioxidant/anti-inflammatory capacity, and (3) paraoxonase-1 activity.
Results:
Of the 42 participants, 35% were women, 35% were white, and the mean age was 27.6 years. The high-frequency component was significantly decreased in the e-cigarette users compared with nonuser control participants (mean [SEM], 46.5 [3.7] nu vs 57.8 [3.6] nu, P = .04). The low-frequency component (mean [SEM], 52. [4.0] nu vs 39.9 [3.8] nu, P = .03) and the low frequency to high frequency ratio (mean, [SEM], 1.37 [0.19] vs 0.85 [0.18], P = .05) were significantly increased in the e-cigarette users compared with nonuser control participants, consistent with sympathetic predominance. Low-density lipoprotein oxidizability, indicative of the susceptibility of apolipoprotein B-containing lipoproteins to oxidation, was significantly increased in e-cigarette users compared with nonuser control individuals (mean [SEM], 3801.0 [415.7] U vs 2413.3[325.0] U, P = .01) consistent with increased oxidative stress, but differences in high-density antioxidant/anti-inflammatory capacity and paraoxonase-1 activity were not significant.
Conclusions and relevance:
In this study, habitual e-cigarette use was associated with a shift in cardiac autonomic balance toward sympathetic predominance and increased oxidative stress, both associated with increased cardiovascular risk.
Heat-not-burn tobacco products (HNB), including Reynolds American's (RA) ‘Eclipse’ and ‘Revo’ and Philip Morris International's (PMI) ‘Heatbar’, are devices that heat tobacco to ∼500°F, producing an inhalable aerosol. Since 1988, tobacco companies have perennially introduced HNB and marketed them as healthier than conventional cigarettes. These claims, refuted by researchers,1 failed to lure consumers. Each reincarnation of HNB was commercially unsuccessful, and most HNB products were discontinued shortly after their introduction. Until recently, HNB products were all but unavailable to consumers—but now may be the perfect time for a thriving HNB market.
Recent enthusiasm for e-cigarettes2 has captured the attention of researchers and the imagination of tobacco executives. E-cigarette use is buoyed by perceptions that they are less harmful than conventional cigarettes.3 However, recent estimates …
The use of tobacco products remains the major preventable cause of cardiovascular disease and mortality. Although much progress has been made in reducing the prevalence of smoking, new opportunities to regulate tobacco products and the recent introduction of e-cigarettes in the market have radically redefined the tobacco landscape. These developments have heightened the need for a more in-depth understanding of the effects of tobacco products on heart disease, and for identifying which components of tobacco products cause cardiovascular damage and which biomarkers and subclinical measures of cardiovascular disease are most reflective of tobacco-induced injury. This understanding is essential not only for developing new regulatory policies, but also for evaluating disease risk that might be associated with the use of new devices such as e-cigarettes. Because the concentration of several harmful and potentially harmful constituents present in cigarette smoke is decreased in e-cigarettes, it has been suggested that the use of e-cigarettes could significantly lessen the burden of cardiovascular disease. E-cigarettes have also been claimed to promote smoking cessation. However, the extent of residual risk associated with carbonyls, particulate matter, nicotine, flavors, and other constituents of e-cigarettes is unclear, and the efficacy of e-cigarettes as cessation devices remains uncertain. Widespread acceptance of these devices could renormalize the use of tobacco products and recruit a new generation of users to nicotine addiction. Therefore, further toxicological, clinical, economic, and marketing research is required to chart a clear, evidence-based pathway for alleviating the cardiovascular disease burden of tobacco products.
The prevalence of vascular disease has increased in both the United States and Europe since the end of World War II. The pathogenesis of vascular disease has been directly linked to changes in dietary habits and lifestyle practices and the discovery of penicillin by Sir Alexander Fleming in 1928, which led to a reduction in deaths secondary to bacterial infections. Multiple theories have evolved regarding the various factors associated with an increased risk of vascular disease. It is important to realize, however, that the study of the pathogenesis and subsequent treatment of vascular disease requires a “bigger picture” approach rather than consideration of just one or two factors. In this chapter, we review the contributions made by many investigators who have looked at one or more of these issues. We discuss the relationship (Fleming’s Unified Theory of Vascular Disease1) between these factors (Figure 64.1) and their overall role in the pathogenesis of vascular disease, including coronary artery disease, carotid artery disease, and peripheral vascular disease. We also review the importance and benefit of looking at each of these contributing factors when evaluating and treating an individual with vascular disease.
Background:
The vascular safety of electronic cigarettes still needs to be clarified. We compared the impact of electronic cigarettes versus traditional cigarettes on oxidative stress and endothelial function in healthy smokers and non-smoker adults.
Methods:
We performed a cross-over single-blind study in 40 healthy subjects (20 smokers, 20 non-smokers, matched for age and sex). Firstly, all subjects smoked T-cigarettes. One week later the same subjects smoked an E-cigarette with the same nominal nicotine content. Blood samples were drawn just before and after smoking and markers of oxidative stress, nitric oxide bioavailability and vitamin E levels were measured. Flow-mediated dilatation (FMD) was also measured.
Results:
Smoking both electronic cigarettes and traditional cigarettes led to a significant increase of the levels of sNox2-dp, 8-isoPGF2α and to a significant decrease of NO bioavailability, vitamin E levels and FMD. Generalizing estimating equation analysis confirmed that all markers of oxidative stress and FMD were significantly affected by smoking and showed that the biologic effects of electronic cigarettes versus traditional cigarettes on vitamin E levels (p=0.413) and FMD (p=0.311) were not statistically different. On the other hand, electronic cigarettes appeared to have a lesser impact than traditional cigarettes on levels of sNox2-dp (p=0.001), 8-isoPGF2α (p=0.046) and NO bioavailability (p=0.001).
Conclusions:
Our study demonstrates that both cigarettes have unfavorable effects on markers of oxidative stress and FMD after single use, although E-cigarette appeared to have a lesser impact. Future studies are warranted to clarify the chronic vascular effects of E-cigarette smoking.
Electronic nicotine delivery systems (ENDS) initially emerged in 2003 and have since become widely available globally, particularly over the Internet.
Data on ENDS usage patterns are limited. The current paper examines patterns of ENDS awareness, use, and product-associated beliefs among current and former smokers in four countries.
Data come from Wave 8 of the International Tobacco Control Four-Country Survey, collected July 2010 to June 2011 and analyzed through June 2012. Respondents included 5939 current and former smokers in Canada (n=1581); the U.S. (n=1520); the United Kingdom (UK; n=1325); and Australia (n=1513).
Overall, 46.6% were aware of ENDS (U.S.: 73%, UK: 54%, Canada: 40%, Australia: 20%); 7.6% had tried ENDS (16% of those aware of ENDS); and 2.9% were current users (39% of triers). Awareness of ENDS was higher among younger, non-minority smokers with higher incomes who were heavier smokers. Prevalence of trying ENDS was higher among younger, nondaily smokers with a high income and among those who perceived ENDS as less harmful than traditional cigarettes. Current use was higher among both nondaily and heavy (≥20 cigarettes per day) smokers. In all, 79.8% reported using ENDS because they were considered less harmful than traditional cigarettes; 75.4% stated that they used ENDS to help them reduce their smoking; and 85.1% reported using ENDS to help them quit smoking.
Awareness of ENDS is high, especially in countries where they are legal (i.e., the U.S. and UK). Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid.
To provide an initial abuse liability assessment of an electronic cigarette (EC) in current tobacco cigarette smokers.
The first of four within-subject sessions was an EC sampling session that involved six, 10-puff bouts (30 seconds inter-puff interval), each bout separated by 30 minutes. In the remaining three sessions participants made choices between 10 EC puffs and varying amounts of money, 10 EC puffs and a varying number of own brand cigarette (OB) puffs, or 10 OB puffs and varying amounts of money using the multiple-choice procedure (MCP). The MCP was completed six times at 30-minute intervals, and one choice was reinforced randomly at each trial.
Clinical laboratory.
Twenty current tobacco cigarette smokers.
Sampling session outcome measures included plasma nicotine, cardiovascular response and subjective effects. Choice session outcome was the cross-over value on the MCP.
EC use resulted in significant nicotine delivery, tobacco abstinence symptom suppression and increased product acceptability ratings. On the MCP, participants chose to receive 10 EC puffs over an average of $1.06 or three OB puffs and chose 10 OB puffs over an average of $1.50 (P < 0.003).
Electronic cigarettes can deliver clinically significant amounts of nicotine and reduce cigarette abstinence symptoms and appear to have lower potential for abuse relative to traditional tobacco cigarettes, at least under certain laboratory conditions.
Summary Data Quality Report Behavioral Risk Factor Surveillance System
- Cdc
- Brfss
CDC. BRFSS 2016 Summary Data Quality Report Behavioral Risk Factor Surveillance
System 2016 Summary Data Quality Report.; 2016.
The Behavioral Risk Factor Surveillance System
CDC. The Behavioral Risk Factor Surveillance System 2017 Summary Data Quality
Report.; 2017. https://www.cdc.gov/brfss/annual_data/2017/pdf/2017-sdqr-508.pdf.
Risk Factor Surveillance System Weighting BRFSS Data BRFSS
- Cdc
- Behavioral
CDC. Behavioral Risk Factor Surveillance System Weighting BRFSS Data BRFSS 2016