Cardiovascular Benefits of Switching From Tobacco to Electronic Cigarettes.

Introduction:
This summary will discuss the article "Cardiovascular Benefits of Switching From Tobacco to Electronic Cigarettes" and the letter in response to the study by Dr. Biondi-Zoccai and colleagues. The reader will learn about the study design, major findings, and the main message regarding the cardiovascular effects of switching from tobacco cigarettes to electronic cigarettes.

Key Points:

* The study (1) was a randomized, single-blind, crossover trial comparing the acute effects of electronic cigarettes (ECs) with and without nicotine to tobacco cigarettes (TCs) in 36 long-term smokers.
* The primary outcome was flow-mediated dilation (FMD), a measure of endothelial function.
* The study found that switching from TCs to ECs, regardless of nicotine content, resulted in significant improvement in FMD compared to TCs.
* There was no significant difference in FMD between the two EC arms (with and without nicotine).
* Secondary outcomes, including pulse-wave velocity, heart rate, biomarkers of inflammation, and platelet reactivity, did not show significant differences between ECs and TCs.
* Dr. Biondi-Zoccai and colleagues questioned the lack of difference between the two EC arms and suggested a sensitivity analysis and comparison of EC puff frequency and style among different arms.
* The authors acknowledged that further investigation is required to understand the impact of nicotine on longer-term vascular function.

Main Message:
The main message of the study is that switching from tobacco cigarettes to electronic cigarettes, regardless of nicotine content, can result in significant improvement in endothelial function in the short term. While nicotine may have pharmacological effects, the study suggests that avoidance of tobacco toxicants may be the primary factor in producing the majority of the benefits. The study's findings add to the growing body of evidence suggesting that electronic cigarettes may be a less harmful alternative to tobacco cigarettes for smokers. However, further investigation is required to understand the long-term impact of electronic cigarettes and nicotine use on cardiovascular health.

Biondi-Zoccai G, Sciarretta S, Carnevale R, Peruzzi M, Frati G. Cardiovascular Benefits of Switching From Tobacco to Electronic Cigarettes. Journal of the American College of Cardiology. 2020;75(13):1613. doi:10.1016/j.jacc.2020.01.045