Cardiovascular and Pulmonary Responses to acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-term Users.

BACKGROUND: The acute cardiovascular and pulmonary effects of contemporary electronic
nicotine delivery systems (ENDS) in long-term users are not known.
RESEARCH QUESTION: What are the cardiovascular and pulmonary responses to an acute 15-
min product use challenge with ENDS and combustible cigarettes in regular nicotinecontaining
product users compared with control participants who do not use tobacco or vape?
STUDY DESIGN AND METHODS: Observational challenge study before and after nicotinecontaining
product use of 395 individuals who used ENDS exclusively (n ¼ 164; exhaled carbon
monoxide level, < 5 parts per million [ppm]; positive urine NicCheck I [Mossman Associates]
results, 82%; fourth-generation ENDS), participants who smoked cigarettes exclusively
(n ¼ 117; carbon monoxide level, > 5 ppm; positive urine NicCheck I results), and control
participants (n ¼ 114; carbon monoxide level, < 5 ppm; negative urine NicCheck I results).
RESULTS: During the 15-min product challenge, cigarette users took a median of 14.0 puffs
(interquartile range [IQR], 9.3 puffs); ENDS users took 9.0 puffs (IQR, 7.5 puffs; P < .001).
After product challenge, compared with control participants, ENDS users showed greater
increases in adjusted mean differences in systolic BP (5.6 mm Hg [95% CI, 4.4-6.8 mm Hg]
vs 2.3 mm Hg [95% CI, 0.8-3.8 mm Hg]; P ¼ .001), diastolic BP (4.2 mm Hg [95% CI, 3.3-
5.0 mm Hg] vs 2.0 mm Hg [95% CI, 1.1-3.0 mm Hg; P ¼ .003), and heart rate (4.8 beats/min
[95% CI, 4.0-5.6 beats/min] vs –1.3 beats/min [95% CI, –2.2 to –0.3 beats/min]; P < .001)
and greater reductions in brachial artery diameter (–0.011 cm [95% CI, –0.013 to 0.009 cm]
vs –0.006 cm [95% CI, –0.004 to –0.009 cm]; P ¼ .003), time-domain heart rate variability
(–7.2 ms [95% CI, –10.5 to –3.7 ms] vs 3.6 ms [95% CI, 1.6-9.3 ms]; P ¼ .001), and FEV1
(ENDS: –4.1 [95% CI, –5.4 to –2.8] vs control participants: –1.1 [95% CI, –2.7 to 0.6]; P ¼
.005) with values similar to those of cigarette users. ENDS users performed worse than
control participants on all exercise parameters, notably metabolic equivalents (METs;
adjusted mean difference, 1.28 METs [95% CI, 0.73-1.83 METs]; P < .001) and 60-s heart
rate recovery (adjusted mean difference, 2.9 beats/min [95% CI, 0.7-5.0 beats/min]; P ¼ .008).

Tattersall MC, hughey CM, Piasecki TM, et al. Cardiovascular and Pulmonary Responses to acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-term Users. Chest. Published online april 10, 2023. doi:10.1016/j.chest.2023.03.047