Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review

Abstract

Background: Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. Study Design: Systematic review. Methods: We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol or glycerol. Results: No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In three studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1012 people exposed to ecigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. Conclusion: We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarette users in the general population and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes.

Vaping Cardiovascular Health Risks: an Updated Umbrella Review

“…For instance, oxidative stress, cytotoxicity, and cardiomyocyte dysfunction are established effects of EVC [33]. Second, EVC impact adversely on BP management, cause tachycardia, and worsen arterial stiffness [19,34]. Third, EVC use has been associated with an increased risk of adverse clinical events, including atrial fibrillation and myocardial infarction, even if the causal link is still debated [24,35].…”

“…Finally, Riley et al conducted a systematic review originally focused on the interplay between hormonal contraception, EVC, and cardiovascular risk [19]. No study explicitly focused on hormonal contraception was retrieved, and thus they expanded their analysis to the pathophysiologic link between EVC and cardiovascular outcomes.…”

“…Substantial evidence continues to accrue on MRP, including results of randomized controlled trials (RCT), and several systematic reviews have already been published on this topic [18••]. However, the interplay between MRP, cardiovascular physiology, and cardiovascular disease is still uncertain, with conflicting results provided by different scholarly sources [19]. We thus aimed at conducting an updated umbrella review of systematic reviews on the cardiovascular effects, in terms of both pathophysiology and symptomatic disease, of EVC and HNBC [20•].…”

Cardiovascular toxicity of nicotine: Implications for electronic cigarette use

“…(33, 34) Studies of more advanced devices with effective nicotine delivery find that e-cigarette use produces the expected heart rate acceleration similar to that seen with cigarette smoking. Blood pressure effects are variable.…”

Cardiovascular effects of electronic cigarettes

“…Any variability in effects across studies is likely to be related to differences in device-specific delivery of nicotine. ECs can cause an acute increase in heart rate, although the extent of this increase varies between studies 80 . In addition, numerous EC studies have also reported an acute increase in blood pressure among users 45,81–83 .…”