E-cigarettes and CV risk: Current state of the evidence for cardiologists

So I guess I'll have to do patches for my nicotine needs post stroke.

Too bad the nicotine gum got cancelled.

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I'm going to do the nicotine patches for my next stroke even though I have no clue on dosage.  Don't listen to me with no medical training. Is your doctor trained in the latest research? Say the last 20 years?

 

E-cigarettes and CV risk: Current state of the evidence for cardiologists

Cardiology Today, June 2019
Olusola A. Orimoloye, MD, MPH; Mohammadhassan Mirbolouk, MD; Michael J. Blaha, MD, MPH

Electronic cigarettes include a diverse group of battery-powered devices that vaporize nicotine-containing, often flavored solvents for inhalation. Initially, these devices were proposed as an alternative cessation strategy for cigarette smokers who are unable to quit using conventional cessation therapies.
However, since their introduction into the U.S. market in 2006, e-cigarettes have gained popularity, especially among youth, and their use (also called vaping) has considerably extended to “never smokers.” In a recent study, it was estimated that as of 2016, almost 2 million U.S. adults who had never smoked cigarettes were current users of these products. With the recent introduction of newer brands (eg, Juul), which can be used more discreetly among teenagers, evidence suggests that e-cigarette use prevalence has trended upward, particularly in youth.

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Olusola A. Orimoloye

In 2016, the FDA extended its regulatory authority to e-cigarettes through the Deeming Rule. However, to guide further regulation of these products in adults, the FDA requires actionable evidence on their health effects, including any potential CV toxicity.

Mohammadhassan Mirbolouk

Vaping and cardiotoxicity

There are many constituent components of inhaled e-cigarette vapor that may be potential candidates for CV toxicity (Table). These include toxic metals such as lead, nickel and chromium; volatile organic compounds (VOCs) such as acrolein, flavoring derivatives; and nicotine, a known trigger for myocardial ischemia and infarction due to stimulation of the sympathetic nervous system. Comparative studies of VOC exposure across a range of tobacco product use behaviors suggest that sole e-cigarette users have significantly greater levels of exposure to VOCs than nonusers of tobacco products, albeit lower than in conventional cigarette smokers.

Michael J. Blaha

Given the popularity of e-cigarette use and the aforementioned concerns about potential CV toxicity, there has therefore been considerable interest in understanding CV risks that may attend the use of these products, in absolute terms, and relative to conventional cigarette smoking.

E-cigarettes and CV risk

Unfortunately, according to the 2018 report of the National Academies of Sciences, Engineering, and Medicine, titled “Public Health Consequences of Electronic Cigarette Use,” there is, as yet, no available evidence as to whether e-cigarette use is associated with clinical CV outcomes such as CHD, peripheral artery disease or stroke, and subclinical disease, including carotid intima-media thickness and coronary artery calcification.

Despite the general availability of laboratory-based animal studies, and short-term exposure studies that have highlighted unfavorable effects of e-cigarette exposure on short-term outcomes such as heart rate variability, oxidative stress and endothelial dysfunction, critical prospective epidemiologic data are sparse (Table).