Summary
Introduction:
In this article, Dr. holly R. Middlekauff discusses the impact of electronic cigarettes (ECs) on cardiovascular disease (CVD) and smoking cessation. The reader will learn about the current state of research on ECs and their potential benefits and risks for CVD prevention and smoking cessation. The article also highlights the need for more longitudinal studies and clear messaging to the public about the use of ECs.
Key Points:
* ECs are a popular alternative to traditional cigarettes, with 4.5% of adults and 20.8% of high school students in the US currently using them.
* Longitudinal studies are necessary to determine if myocardial infarction incidence is lower in chronic EC users compared to TC smokers.
* Biomarker studies suggest that EC use may increase sympathetic nerve activity, oxidative stress, inflammation, endothelial dysfunction, and arterial stiffness, but not to the same degree as TC smoking.
* In a small study, chronic EC users had abnormal heart rate variability (hRV) consistent with increased sympathetic nerve activity, which is associated with increased CVD risk.
* Nicotine, not non-nicotine constituents, acutely increases oxidative stress in EC users.
* human imaging studies support the concept that EC use leads to activation of inflammatory pathways, with implications for the development of inflammatory atherosclerosis, plaque progression and instability, and acute myocardial ischemia.
* EC use, especially an EC with nicotine, leads to acute vascular dysfunction. Whether this acute vascular dysfunction translates into sustained vascular dysfunction remains unknown.
* The main message is that while ECs may be less harmful than TCs, they are not harmless. The impact of ECs on CVD risk may be vastly different in middle-aged breadwinners addicted to TCs compared to young, never-smoking high school students. Therefore, clear and unwavering messaging to the public is necessary, emphasizing that non-TC smokers should not use ECs.
Main Message:
The main message of this article is that while ECs may be a reasonable strategy for TC smoking cessation if all FDa-certified strategies have been tried without success, they should not be used by non-TC smokers. The long-term effects of EC use on CVD risk are not yet clear, and biomarker studies suggest that EC use may increase sympathetic nerve activity, oxidative stress, inflammation, endothelial dysfunction, and arterial stiffness. Therefore, clear and unwavering messaging to the public is necessary, emphasizing that non-TC smokers should not use ECs.
Citation
Middlekauff, holly R. “Cardiovascular Impact of Electronic-Cigarette Use.” Trends in Cardiovascular Medicine 30, no. 3 (april 2020): 133–40. https://doi.org/10.1016/j.tcm.2019.04.006.
