Cardiovascular effects of electronic cigarettes

Abstract

Cardiovascular safety is an important consideration in the debate on the benefits versus the risks of electronic cigarette (EC) use. EC emissions that might have adverse effects on cardiovascular health include nicotine, oxidants, aldehydes, particulates, and flavourants. To date, most of the cardiovascular effects of ECs demonstrated in humans are consistent with the known effects of nicotine. Pharmacological and toxicological studies support the biological plausibility that nicotine contributes to acute cardiovascular events and accelerated atherogenesis. However, epidemiological studies assessing Swedish smokeless tobacco, which exposes users to nicotine without combustion products, generally have not found an increased risk of myocardial infarction or stroke among users, but suggest that nicotine might contribute to acute cardiovascular events, especially in those with underlying coronary heart disease. The effects of aldehydes, particulates, and flavourants derived from ECs on cardiovascular health have not been determined. Although ECs might pose some cardiovascular risk to users, particularly those with existing cardiovascular disease, the risk is thought to be less than that of cigarette smoking based on qualitative and quantitative comparisons of EC aerosol versus cigarette smoke constituents. The adoption of ECs rather than cigarette smoking might, therefore, result in an overall benefit for public health.

Limited mutagenicity of electronic cigarettes in mouse or human cells in vitro

“…Future investigations are needed to determine whether e-cig vapor may exert epigenetic effects of relevance to carcinogenesis. Equally important is to recognize that e-cig use, in addition to possible carcinogenic effects, may also have other disease-causing effects, such as pulmonary or cardiopulmonary effects [87]. …”

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

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

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

Diet, Lifestyle, Smoking

“…Nicotine replacement therapies, bupropion and varenicline, have been shown to be helpful in increasing quitting (Cahill et al 2013;Hughes et al 2014;Stead et al 2012). Electronic cigarettes emitting an aerosol containing nicotine have been developed to aid quitting; however, they may also emit toxic gases that may increase the risk of cardiovascular and pulmonary diseases, arrhythmias and hypertension (Benowitz and Fraiman 2017). Patients often are concerned about weight gain after smoking cessation.…”