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Chen C, Huo C, Mattey-Mora PP, Bidulescu A, Parker MA. Assessing the association between e-cigarette use and cardiovascular disease: A meta-analysis of exclusive and dual use with combustible cigarettes. Addict Behav 2024; 157:108086. [PMID: 38917766 DOI: 10.1016/j.addbeh.2024.108086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Growing evidence highlights the impact of e-cigarette use on cardiovascular health, prompting a crucial examination of its association with cardiovascular disease (CVD) in both exclusive e-cigarette and dual use scenarios with combustible cigarettes. This meta-analysis assessed the association between e-cigarette use and CVD by synthesizing the existing literature. METHODS Pertinent observational studies were identified using multiple electronic databases, from August 22nd, 2006, to April 10th, 2024. A meta-analysis was conducted using random-effect models. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. FINDINGS A total of 20 observational studies involving 8,499,444 participants were included in the meta-analysis. Dual use (e-cigarettes and combustible cigarette) increased the odds of CVD by 2.56 times (95 % CI: 2.11, 3.11) compared to never use of both. Current e-cigarette use combined with former combustible cigarette increased the odds of CVD by 2.02 times (95 % CI: 1.58, 2.58) compared to never use of either. Exclusive current e-cigarette use did not show a statistically significant association with CVD odds compared to never use of either (OR = 1.24, 95 % CI: 0.93, 1.67). CONCLUSIONS Dual use of e-cigarettes and combustible cigarettes was significantly associated with CVD, but results failed to show a significant association between exclusive e-cigarette use and CVD. Robust and longitudinal studies are needed to understand the long-term implications of e-cigarette use and CVD. Public health efforts should focus on awareness, smoking cessation, and regulating both e-cigarettes and combustible cigarettes.
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Affiliation(s)
- Chen Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Cuiqiong Huo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Paola P Mattey-Mora
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Maria A Parker
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
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Jin L, Richardson A, Lynch J, Lorkiewicz P, Srivastava S, Fryar L, Miller A, Theis W, Shirk G, Bhatnagar A, Srivastava S, Riggs DW, Conklin DJ. Formaldehyde and the transient receptor potential ankyrin-1 contribute to electronic cigarette aerosol-induced endothelial dysfunction in mice. Toxicol Sci 2024; 201:331-347. [PMID: 39067042 PMCID: PMC11424888 DOI: 10.1093/toxsci/kfae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Electronic nicotine delivery systems (ENDS) aerosol exposures can induce endothelial dysfunction (ED) in healthy young humans and animals. Thermal degradation of ENDS solvents, propylene glycol, and vegetable glycerin (PG: VG), generates abundant formaldehyde (FA) and other carbonyls. Because FA can activate the transient receptor potential ankyrin-1 (TRPA1) sensor, we hypothesized that FA in ENDS aerosols provokes TRPA1-mediated changes that include ED and "respiratory braking"-biomarkers of harm. To test this, wild-type (WT) and TRPA1-null mice were exposed by inhalation to either filtered air, PG: VG-derived aerosol, or FA (5 ppm). Short-term exposures to PG: VG and FA-induced ED in female WT but not in female TRPA1-null mice. Moreover, acute exposures to PG: VG and FA stimulated respiratory braking in WT but not in TRPA1-null female mice. Urinary metabolites of FA (ie, N-1,3-thiazolidine-4-carboxylic acid, TCA; N-1,3-thiazolidine-4-carbonyl glycine, TCG) and monoamines were measured by LC-MS/MS. PG: VG and FA exposures significantly increased urinary excretion of both TCA and TCG in both WT and TRPA1-null mice. To confirm that inhaled FA directly contributed to urinary TCA, mice were exposed to isotopic 13C-FA gas (1 ppm, 6 h). 13C-FA exposure significantly increased the urine level of 13C-TCA in the early collection (0 to 3 h) supporting a direct relationship between inhaled FA and TCA. Collectively, these data suggest that ENDS use may increase CVD risk dependent on FA, TRPA1, and catecholamines, yet independently of either nicotine or flavorants. This study supports that levels of FA in ENDS-derived aerosols should be lowered to mitigate CVD risk in people who use ENDS.
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Affiliation(s)
- Lexiao Jin
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Andre Richardson
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Jordan Lynch
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Pawel Lorkiewicz
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
| | - Shweta Srivastava
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
| | - Laura Fryar
- School of Medicine, University of Louisville, Louisville, KY 40202, United States
| | - Alexis Miller
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Whitney Theis
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Gregg Shirk
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
| | - Aruni Bhatnagar
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
| | - Sanjay Srivastava
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
| | - Daniel W Riggs
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
| | - Daniel J Conklin
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY 40202, United States
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY 40202, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, United States
- Superfund Research Center, University of Louisville, Louisville, KY 40202, United States
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Benam KH. Multidisciplinary approaches in electronic nicotine delivery systems pulmonary toxicology: emergence of living and non-living bioinspired engineered systems. COMMUNICATIONS ENGINEERING 2024; 3:123. [PMID: 39227652 PMCID: PMC11372223 DOI: 10.1038/s44172-024-00276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024]
Abstract
Technology-based platforms offer crucial support for regulatory agencies in overseeing tobacco products to enhance public health protection. The use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes, has surged exponentially over the past decade. However, the understanding of the impact of ENDS on lung health remains incomplete due to scarcity of physiologically relevant technologies for evaluating their toxicity. This review examines the societal and public health impacts of ENDS, prevalent preclinical approaches in pulmonary space, and the application of emerging Organ-on-Chip technologies and bioinspired robotics for assessing ENDS respiratory toxicity. It highlights challenges in ENDS inhalation toxicology and the value of multidisciplinary bioengineering approaches for generating reliable, human-relevant regulatory data at an accelerated pace.
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Affiliation(s)
- Kambez H Benam
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Mills A, Nassabeh S, Hurley A, Shouldis L, Chantler PD, Dakhlallah D, Olfert IM. Influence of gestational window on offspring vascular health in rodents with in utero exposure to electronic cigarettes. J Physiol 2024; 602:4271-4289. [PMID: 39106241 PMCID: PMC11376404 DOI: 10.1113/jp286493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/04/2024] [Indexed: 08/09/2024] Open
Abstract
Studies have shown cerebrovascular dysfunction in offspring with full-gestational electronic cigarette (Ecig) exposure, but little is known about how individual trimester exposure impacts offspring health. This study aimed to determine if there is a critical window during gestation that contributes to vascular and anxiety-like behavioural changes seen with full-term exposure. To test this, rats were time-mated, and the pregnant dams were randomly assigned to Ecig exposure during first trimester (gestational day, GD2-7), second trimester (GD8-14), third trimester (GD15-21) or full-term gestation (GD2-21). We also assessed the effect of maternal preconception exposure. Both male and female offspring from all maternal exposure conditions were compared to offspring from dams under ambient air (control) conditions. Ecig exposure consisted of 60-puffs/day (5 days/week) using either 5 or 30 watts for each respective exposure group. We found that maternal exposure to Ecig in the second and third trimesters resulted in a decrease (23-38%) in vascular reactivity of the middle cerebral artery (MCA) reactivity in 3- and 6-month-old offspring compared to Air offspring. Further, the severity of impairment was comparable to the full-term exposure (31-46%). Offspring also displayed changes in body composition, body mass, anxiety-like behaviour and locomotor activity, indicating that Ecigs influence neurodevelopment and metabolism. Maternal preconception exposure showed no impact on offspring body mass, anxiety-like behaviour, or vascular function. Thus, the critical exposure window where Ecig affects vascular development in offspring occurs during mid- to late-gestation in pregnancy, and both 5 W and 30 W exposure produce significant vascular dysfunction compared to Air. KEY POINTS: Exposure to electronic cigarettes (Ecigs) is known to increase risk factors for cardiovascular disease in both animals and humans. Maternal Ecig use during pregnancy in rodents is found to impair the vascular health of adolescent and adult offspring, but the critical gestation window for Ecig-induced vascular impairment is not known. This study demonstrates Ecig exposure during mid- and late-gestation (i.e. second or third trimester) results in impaired endothelial cell-mediated dilatation (i.e. middle cerebral artery reactivity) and alters anxiety-like behaviour in offspring. Maternal exposure prior to conception did not impact offspring's vascular or anxiety-like behavioural outcomes. Rodent models have been a reliable and useful predictor of inhalation-induced harm to humans. These data indicate maternal use of Ecigs during pregnancy should not be considered safe, and begin to inform clinicians and women about potential long-term harm to their offspring.
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Affiliation(s)
- Amber Mills
- Department of Physiology, Pharmacology & Toxicology, West Virginia University School of Medicine, Morgantown, WV, USA
- Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sydney Nassabeh
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Audra Hurley
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Lainey Shouldis
- Department of Immunology and Microbial Pathogenesis, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Paul D Chantler
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Duaa Dakhlallah
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - I Mark Olfert
- Department of Physiology, Pharmacology & Toxicology, West Virginia University School of Medicine, Morgantown, WV, USA
- Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV, USA
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV, USA
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Mills A, Velayutham M, Corbin D, Suter L, Robinson M, Khramtsov VV, Shouldis L, Cook M, Dakhallah D, Chantler PD, Olfert IM. Maternal use of electronic cigarettes and impact on offspring: a double-hit model. J Appl Physiol (1985) 2024; 137:690-704. [PMID: 39088647 PMCID: PMC11424175 DOI: 10.1152/japplphysiol.00345.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/03/2024] [Accepted: 07/24/2024] [Indexed: 08/03/2024] Open
Abstract
Endothelial dysfunction is a predictor for cardiovascular disease. Preclinical data suggest longstanding cardiovascular and cerebrovascular dysfunction occurs in offspring with perinatal electronic cigarette (Ecig) exposure. Furthermore, direct use of Ecigs increases reactive oxygen species and impairs cerebrovascular function, but the combined effect of direct use in offspring with a history of perinatal exposure (i.e. double-hit condition) is not known. We tested the hypothesis that offspring with double-hit Ecig exposure will lead to greater cerebrovascular and neurocognitive dysfunction compared with in utero exposure only. Male and female offspring were obtained from time-mated Sprague Dawley female rats exposed to air (n = 5 dams) or Ecig exposed (n = 5 dams) and studied at either 3 or 6 mo after birth. Ecig exposure for double-hit offspring began at 1-mo before the timepoints and lasted 4 wk (5 days/wk with 90-min exposure/day). We found double-hit offspring (Ecig:Ecig = exposure dam:offspring) sustained further blunted middle cerebral artery (MCA) reactivity, increased severity of neuronal damage, and increased interactions of astrocytes and endothelial cells compared with offspring with maternal (Ecig:Air) or direct (Air:Ecig) exposure only. Circulating extracellular vesicles (EVs) were increased, whereas sirtuin 1 (SIRT1) was decreased, in all Ecig-exposed groups compared with controls (Air:Air), with Ecig:Ecig group showing the greatest respective change for each. Electron paramagnetic resonance (EPR) spectroscopy revealed oxidative stress was the highest in the plasma of Ecig:Ecig group (P < 0.05) than the other groups. These data show that a double-hit exposure in adolescent or adult offspring results in a greater decline in cerebrovascular function, biomarkers of neuronal dysfunction, and increased circulation of EVs compared with a single-hit exposure.NEW & NOTEWORTHY These data add to the growing body of literature demonstrating that electronic cigarette (Ecig) use during pregnancy (even without nicotine) is not safe, and primes offspring to have worse cardiovascular health outcomes in early and adult life. A key finding from this work is that a second insult from direct vaping in offspring with prior in utero exposure induces greater vascular dysfunction, increased oxidative stress, and shows evidence of neuronal dysfunction compared with either direct- or maternal-only exposure.
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Affiliation(s)
- Amber Mills
- Department of Physiology, Pharmacology, and Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Murugesan Velayutham
- Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- In vivo Multifunctional Magnetic Resonance (IMMR) Center, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Department of Biochemistry and Molecular Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Debbie Corbin
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Lindsey Suter
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Madison Robinson
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Valery V Khramtsov
- In vivo Multifunctional Magnetic Resonance (IMMR) Center, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Department of Biochemistry and Molecular Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Lainey Shouldis
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Mary Cook
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Duaa Dakhallah
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Paul D Chantler
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - I Mark Olfert
- Department of Physiology, Pharmacology, and Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States
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Simovic T, Matheson C, Cobb K, Heefner A, Thode C, Colon M, Tunon E, Billingsley H, Salmons H, Ahmed SI, Carbone S, Garten R, Breland A, Cobb CO, Nana-Sinkam P, Rodriguez-Miguelez P. Young users of electronic cigarettes exhibit reduced cardiorespiratory fitness. J Appl Physiol (1985) 2024; 137:569-580. [PMID: 38990977 PMCID: PMC11424176 DOI: 10.1152/japplphysiol.00292.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024] Open
Abstract
Electronic nicotine delivery systems, often referred to as e-cigarettes, are popular tobacco products frequently advertised as safer alternatives to traditional cigarettes despite preliminary data suggesting a potential negative cardiovascular impact. Cardiorespiratory fitness is a critical cardiovascular health marker that is diminished in individuals who consume traditional tobacco products. Whether the use of e-cigarettes impacts cardiorespiratory fitness is currently unknown. Thus, the purpose of this study was to investigate the impact of regular e-cigarette use on cardiorespiratory fitness in young healthy adults. Twenty-six users of e-cigarettes (ECU, 13 males, and 13 females; age: 24 ± 3 yr; e-cigarette usage 4 ± 2 yr) and 16 demographically matched nonusers (NU, 6 males, and 10 females; age: 23 ± 3 yr) participated in this study. Cardiorespiratory fitness was measured by peak oxygen consumption (V̇o2peak) during a cardiopulmonary exercise test. Measurements of chronotropic response, hemodynamic, oxygen extraction, and utilization were also evaluated. Our results suggest that regular users of e-cigarettes exhibited significantly lower peak oxygen consumption when compared with nonusers, even when controlled by fat-free mass and lean body mass. Hemodynamic changes were not different between both groups during exercise, whereas lower chronotropic responses and skeletal muscle oxygen utilization were observed in users of e-cigarettes. Results from the present study demonstrate that young, apparently healthy, regular users of e-cigarettes exhibit significantly reduced cardiorespiratory fitness, lower chronotropic response, and impaired skeletal muscle oxygen utilization during exercise. Overall, our findings contribute to the growing body of evidence that supports adverse effects of regular e-cigarette use on cardiovascular health.NEW & NOTEWORTHY E-cigarettes are tobacco products frequently used by youth and young adults. Little is known about the long-term health effects of their prolonged use. Results from the present study demonstrate that young, apparently healthy, regular users of e-cigarettes exhibit significantly reduced cardiorespiratory fitness, a marker of cardiovascular health and a predictor of all-cause mortality. We also identified that the young users of e-cigarettes present with lower chronotropic response and impaired skeletal muscle oxygen utilization during exercise.
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Affiliation(s)
- Tijana Simovic
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Chloe Matheson
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Kolton Cobb
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Allison Heefner
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Christopher Thode
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Marisa Colon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Enrique Tunon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Hayley Billingsley
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Hannah Salmons
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Syed Imran Ahmed
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Salvatore Carbone
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ryan Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Alison Breland
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Patrick Nana-Sinkam
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, United States
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, United States
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Poudel R, Li S, Hong H, Zhao J, Srivastava S, Robertson RM, Hall JL, Srivastava S, Hamburg NM, Bhatnagar A, Keith RJ. Catecholamine levels with use of electronic and combustible cigarettes. Tob Induc Dis 2024; 22:TID-22-144. [PMID: 39144677 PMCID: PMC11320712 DOI: 10.18332/tid/190687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Smoking elevates catecholamines that increase the risk for cardiovascular disease. Sparse evidence exists about the effects of e-cigarettes and catecholamines. Higher levels of catecholamines could trigger the increased heart rate, blood pressure, and decreased vascular function reported with the use of e-cigarettes. We investigated the difference in urinary catecholamines and their metabolites before and after the use of an e-cigarette containing nicotine or cigarettes compared to no tobacco use. METHODS In our observational cohort exposure study, healthy adults aged 21-45 years who were currently using e-cigarettes, cigarettes, or had never used tobacco, participated in an acute exposure visit using their most common tobacco product. Urine was collected before, 1, and 2 hours after a 3-second puff every 30 seconds for 10 minutes on an e-cigarette or straw or use of 1 cigarette. Urinary catecholamines and their metabolites were measured by ultra-high-performance liquid chromatography. Participants (n=323) were grouped by the product used at the visit. We compared levels of creatinine normalized log-transformed urinary catecholamines and their metabolites across groups using Dunn's test following a Kruskal-Wallis test in unadjusted and demographically adjusted models. RESULTS Prior to use, individuals who used cigarettes (n=70) had lower urinary metabolites from epinephrine, serotonin, and norepinephrine. No differences were seen in those who used e-cigarettes (n=171) and those who did not use tobacco (n=82). In fully adjusted models, 1 h after the use of a combustible or e-cigarette, log-transformed urinary metabolites from norepinephrine (β=1.22; 95% CI: 0.39-2.05, p=0.004 and β=1.06; 95% CI: 0.39-1.74, p=0.002), dopamine (β=0.37; 95% CI: 0.24-0.5, p<0.001 and β=0.15; 95% CI: 0.05-0.26, p<0.001), and epinephrine (β=1.89; 95% CI: 0.51-3.27, p=0.008 and β=1.49; 95% CI: 0.38-2.61, p=0.009) were elevated. In fully adjusted models, combustible cigarette use was associated with elevated urinary norepinephrine (β=0.46; 95% CI: 0.13-0.81, p=0.007) and dopamine (β=0.19; 95% CI: 0.06-0.31, p=0.003) 1 h after use. CONCLUSIONS We found that the use of both e-cigarettes and cigarettes was associated with elevated urinary catecholamines or their metabolites. Catecholamines could be useful as a biomarker of harm for tobacco use and considered by tobacco regulatory scientists in future research.
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Affiliation(s)
- Remy Poudel
- American Heart Association, Dallas, United States
| | - Shen Li
- American Heart Association, Dallas, United States
| | - Haoyun Hong
- American Heart Association, Dallas, United States
| | - Juan Zhao
- American Heart Association, Dallas, United States
| | - Shweta Srivastava
- Department of Medicine, Envirome Institute, University of Louisville, Louisville, United States
| | | | | | - Sanjay Srivastava
- Department of Medicine, Envirome Institute, University of Louisville, Louisville, United States
| | - Naomi M. Hamburg
- Whitaker Cardiovascular Institute, Chobanian & Avedisian School of Medicine, Boston University, Boston, United States
| | - Aruni Bhatnagar
- Department of Medicine, Envirome Institute, University of Louisville, Louisville, United States
| | - Rachel J. Keith
- Department of Medicine, Envirome Institute, University of Louisville, Louisville, United States
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Sultan S, Lesloom F. Association of cigarette smoking with cardiometabolic risk factors: A cross-sectional study. Tob Induc Dis 2024; 22:TID-22-136. [PMID: 39072281 PMCID: PMC11274995 DOI: 10.18332/tid/191246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/23/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Despite strong and consistent epidemiological evidence linking cigarette smoking to several cardiovascular diseases (CVDs), the association between smoking intensity and CVD risk factors remains unclear. This study aimed to explore the possible effects of cigarette smoking on cardiometabolic risk in healthy individuals. METHODS This cross-sectional study was conducted between November 2022 and June 2023. Consecutive sampling was performed to include 160 healthy participants: 100 smokers with 60 males and 40 females; and 60 age- and sex-matched non-smokers with 36 males and 24 females. Blood samples were taken from each participant to assess their cardiometabolic function: lipid profile, von Willebrand factor (vWF), high-sensitivity cardiac troponin I (hs-cTnI), and fibrinogen levels; and liver function using an automated enzymatic method. In addition, blood sugar level, body mass index (BMI), and blood pressure were recorded. RESULTS Smokers had significantly higher vWF functional activity and hs-cTnI but significantly lower albumin and total bilirubin levels than non-smokers (65.87 ± 19.07 vs 56.45 ± 6.59, respectively, p<0.001; 0.0382 ± 0.0077 vs 0.0147 ± 0.0105, respectively, p<0.001; and 4.63 ± 0.32 vs 4.74 ± 0.28, respectively, p=0.026). The number of cigarettes consumed daily was associated positively and significantly with plasma levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, vWF functional activity, and hs-cTnI but were negatively associated with total bilirubin. Moreover, heavy smokers had a significantly higher BMI and waist-to-hip ratio among male smokers than non-smokers. CONCLUSIONS Cigarette smoking was associated with increased dyslipidemia, BMI, and central obesity, in addition to higher vWF functional activity. Altogether, increased hs-cTnI levels in smokers indicate a higher susceptibility to CVD.
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Affiliation(s)
- Samar Sultan
- Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Regenerative Medicine Unit, King Fahad Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fouzy Lesloom
- Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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9
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Mousavi I, Suffredini J, Virani SS, Ballantyne C, Michos ED, Misra A, Saeed A, Jia X. Early Onset Atherosclerotic Cardiovascular Disease. Eur J Prev Cardiol 2024:zwae240. [PMID: 39041374 DOI: 10.1093/eurjpc/zwae240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 07/24/2024]
Abstract
Recent trends indicate a concerning increase in early-onset atherosclerotic cardiovascular disease (ASCVD) among younger individuals (age < 55 in men and <65 in women). These findings highlight the pathobiology of ASCVD as a disease process that begins early in life and underscores the need for more tailored screening methods and preventive strategies. Increasing attention has been placed on the growing burden of traditional cardiometabolic risk factors in young individuals while also recognizing unique factors that mediate risk of premature atherosclerosis in this demographic such as substance use, socioeconomic disparities, adverse pregnancy outcomes, and chronic inflammatory states that contribute to the increasing incidence of early ASCVD. Additionally, mounting evidence has pointed out significant disparities in the diagnosis and management of early ASCVD and cardiovascular outcomes based on sex and race. Moving toward a more personalized approach, emerging data and technological developments using diverse tools such as polygenic risk scores and coronary artery calcium scans have shown potential in earlier detection of ASCVD risk. Thus, we review current evidence on causal risk factors that drive the increase in early ASCVD and highlight emerging tools to improve ASCVD risk assessment in young individuals.
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Affiliation(s)
- Idine Mousavi
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Suffredini
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, TX, USA
| | - Christie Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arunima Misra
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Anum Saeed
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Herzog C, Jones A, Evans I, Raut JR, Zikan M, Cibula D, Wong A, Brenner H, Richmond RC, Widschwendter M. Cigarette Smoking and E-cigarette Use Induce Shared DNA Methylation Changes Linked to Carcinogenesis. Cancer Res 2024; 84:1898-1914. [PMID: 38503267 PMCID: PMC11148547 DOI: 10.1158/0008-5472.can-23-2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/30/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Tobacco use is a major modifiable risk factor for adverse health outcomes, including cancer, and elicits profound epigenetic changes thought to be associated with long-term cancer risk. While electronic cigarettes (e-cigarettes) have been advocated as harm reduction alternatives to tobacco products, recent studies have revealed potential detrimental effects, highlighting the urgent need for further research into the molecular and health impacts of e-cigarettes. Here, we applied computational deconvolution methods to dissect the cell- and tissue-specific epigenetic effects of tobacco or e-cigarette use on DNA methylation (DNAme) in over 3,500 buccal/saliva, cervical, or blood samples, spanning epithelial and immune cells at directly and indirectly exposed sites. The 535 identified smoking-related DNAme loci [cytosine-phosphate-guanine sites (CpG)] clustered into four functional groups, including detoxification or growth signaling, based on cell type and anatomic site. Loci hypermethylated in buccal epithelial cells of smokers associated with NOTCH1/RUNX3/growth factor receptor signaling also exhibited elevated methylation in cancer tissue and progressing lung carcinoma in situ lesions, and hypermethylation of these sites predicted lung cancer development in buccal samples collected from smokers up to 22 years prior to diagnosis, suggesting a potential role in driving carcinogenesis. Alarmingly, these CpGs were also hypermethylated in e-cigarette users with a limited smoking history. This study sheds light on the cell type-specific changes to the epigenetic landscape induced by smoking-related products. SIGNIFICANCE The use of both cigarettes and e-cigarettes elicits cell- and exposure-specific epigenetic effects that are predictive of carcinogenesis, suggesting caution when broadly recommending e-cigarettes as aids for smoking cessation.
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Affiliation(s)
- Chiara Herzog
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria
- Research Institute for Biomedical Aging, Universität Innsbruck, Innsbruck, Austria
| | - Allison Jones
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Iona Evans
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Janhavi R. Raut
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michal Zikan
- Department of Gynecology and Obstetrics, First Faculty of Medicine and Hospital Na Bulovce, Charles University in Prague, Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rebecca C. Richmond
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Martin Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Innsbruck, Austria
- Research Institute for Biomedical Aging, Universität Innsbruck, Innsbruck, Austria
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, United Kingdom
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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11
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Saad D, Ghazala Z, Jesus A, Atteri M, Arundathi R, Ararat E. Preoperative vaping screening in pediatric patients. Pediatr Pulmonol 2024; 59:1832-1835. [PMID: 38506400 DOI: 10.1002/ppul.26981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Dima Saad
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Zena Ghazala
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Apuya Jesus
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Meenakshi Atteri
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Reddy Arundathi
- Department of Anesthesiology, Division of Pediatric Anesthesia and Pain Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erhan Ararat
- Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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12
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Lee J, Yao Z, Boakye E, Blaha MJ. The impact of chronic electronic cigarette use on endothelial dysfunction measured by flow-mediated vasodilation: A systematic review and meta-analysis. Tob Induc Dis 2024; 22:TID-22-84. [PMID: 38779295 PMCID: PMC11110651 DOI: 10.18332/tid/186932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Despite electronic cigarettes (e-cigarettes) being marketed as a safer alternative to combustible cigarettes, the effects of chronic e-cigarette use on vascular health remain uncertain. Our meta-analysis aimed to assess the health implications of chronic exclusive e-cigarette use on endothelial dysfunction, as measured by flow-mediated vasodilation (FMD). METHODS PubMed, Embase and Scopus were searched for studies from 1 January 2004 to 31 March 2024. Four cross-sectional studies (n=769) were pooled using a random-effects model. The mean differences (MD) of FMD were reported by comparing exclusive e-cigarette use versus non-use; exclusive e-cigarette use versus combustible cigarette use; and combustible cigarette use versus non-use. RESULTS A non-significant reduction in FMD in exclusive e-cigarette use compared to non-use was reported (MD of FMD: -1.47%; 95% CI: -3.96 - 1.02; I2= 84%). Similar MD of FMD in exclusive e-cigarette use and exclusive combustible cigarette use (vs non-use) suggested that both of these products might have comparable adverse influences on endothelial health. CONCLUSIONS The limited availability of studies assessing the chronic impact of e-cigarette use restricted our ability to provide definitive findings. We emphasize the importance of additional research that explores the long-term impact of e-cigarette use on endothelial dysfunction, and identify key areas and give suggestions for further study.
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Affiliation(s)
- Jieun Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Zhiqi Yao
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
| | - Michael J. Blaha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, United States
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Bernhard D, Messner B. Vaping Versus Smoking: Are Electronic-Cigarettes the Savior? Arterioscler Thromb Vasc Biol 2024; 44:1012-1015. [PMID: 38657033 DOI: 10.1161/atvbaha.123.319575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- David Bernhard
- Division of Pathophysiology, Institute of Physiology and Pathophysiology (D.B.)
- Medical Faculty, Johannes-Kepler-University Linz, Austria (D.B.)
- Clinical Research Institute for Cardiovascular and Metabolic Diseases, Medical Faculty, Johannes-Kepler-University Linz, Austria (D.B.)
| | - Barbara Messner
- Department of Cardiac Surgery, Cardiac Surgery Research Laboratory, Medical University of Vienna, Austria (B.M.)
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14
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Matheson C, Simovic T, Heefner A, Colon M, Tunon E, Cobb K, Thode C, Breland A, Cobb CO, Nana-Sinkam P, Garten R, Rodriguez-Miguelez P. Evidence of premature vascular dysfunction in young adults who regularly use e-cigarettes and the impact of usage length. Angiogenesis 2024; 27:229-243. [PMID: 38345700 PMCID: PMC11021332 DOI: 10.1007/s10456-023-09903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Electronic (e-) cigarettes are increasingly popular tobacco products on the US market. Traditional tobacco products are known to cause vascular dysfunction, one of the earliest indicators of cardiovascular disease (CVD) development. However, little is known about the effect of regular e-cigarette use on vascular function. The purpose of this study was to investigate the impact of regular e-cigarette use on vascular function and cardiovascular health in young, healthy adults. METHODS Twenty-one regular users of e-cigarettes (ECU) and twenty-one demographically matched non-users (NU) completed this study. Vascular health was assessed in the cutaneous microcirculation through different reactivity tests to evaluate overall functionality, endothelium-dependent vasodilation (EDD), and endothelium-independent vasodilation (EID). Macrovascular function was assessed using flow-mediated dilation (FMD). RESULTS Our results suggest that regular users of e-cigarettes present with premature microvascular impairment when compared to non-users. Specifically, they exhibit lower hyperemic (p = 0.003), thermal (p = 0.010), and EDD (p = 0.004) responses. No differences in EID between the groups were identified. We also identified that individuals who use e-cigarettes for longer than 3 years also present with systemic manifestations, as observed by significantly reduced macrovascular (p = 0.002) and microvascular (p ≤ 0.044) function. CONCLUSIONS Our novel data suggests that young, apparently healthy, regular users of e-cigarettes present with premature vascular dysfunction in the microcirculation when compared to non-users. We have also identified systemic vascular dysfunction affecting both the micro and macrovasculature in those young individuals who used e-cigarettes for longer than 3 years. Taken together, these findings associate regular e-cigarette use with premature vascular dysfunctions and adverse cardiovascular outcomes.
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Affiliation(s)
- Chloe Matheson
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Tijana Simovic
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Allison Heefner
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Marisa Colon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Enrique Tunon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Kolton Cobb
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Christopher Thode
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Alison Breland
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Patrick Nana-Sinkam
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, 817 West Franklin Street, Richmond, VA, 23284, USA.
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA.
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15
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Qazi SU, Ansari MHUH, Ghazanfar S, Ghazanfar SS, Farooq M. Comparison of Acute Effects of E-cigarettes With and Without Nicotine and Tobacco Cigarettes on Hemodynamic and Endothelial Parameters: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev 2024; 31:225-237. [PMID: 38668958 DOI: 10.1007/s40292-024-00643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/11/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently. AIMS This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC-) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC). METHODS Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC- and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC-. However, EC+ was observed to cause less detrimental effect on SBP (WMD = - 4.72 mmHg, 95% CI [- 6.58, - 2.86], p < 0.01), and HR (WMD = - 3.11 BPM, 95% CI [- 4.54, - 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = - 1.14 mmHg, 95% CI [- 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC- but to a lesser degree as compared to TC. CONCLUSION EC+ shows greater impairment in hemodynamic and endothelial parameters than EC- but less than TC. Additional studies are needed to evaluate prolonged effects of EC use.
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Affiliation(s)
- Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Shamas Ghazanfar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Minaam Farooq
- Department of Neurological Surgery, King Edward Medical University, Lahore, Pakistan
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Chandy M, Hill T, Jimenez-Tellez N, Wu JC, Sarles SE, Hensel E, Wang Q, Rahman I, Conklin DJ. Addressing Cardiovascular Toxicity Risk of Electronic Nicotine Delivery Systems in the Twenty-First Century: "What Are the Tools Needed for the Job?" and "Do We Have Them?". Cardiovasc Toxicol 2024; 24:435-471. [PMID: 38555547 DOI: 10.1007/s12012-024-09850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
Cigarette smoking is positively and robustly associated with cardiovascular disease (CVD), including hypertension, atherosclerosis, cardiac arrhythmias, stroke, thromboembolism, myocardial infarctions, and heart failure. However, after more than a decade of ENDS presence in the U.S. marketplace, uncertainty persists regarding the long-term health consequences of ENDS use for CVD. New approach methods (NAMs) in the field of toxicology are being developed to enhance rapid prediction of human health hazards. Recent technical advances can now consider impact of biological factors such as sex and race/ethnicity, permitting application of NAMs findings to health equity and environmental justice issues. This has been the case for hazard assessments of drugs and environmental chemicals in areas such as cardiovascular, respiratory, and developmental toxicity. Despite these advances, a shortage of widely accepted methodologies to predict the impact of ENDS use on human health slows the application of regulatory oversight and the protection of public health. Minimizing the time between the emergence of risk (e.g., ENDS use) and the administration of well-founded regulatory policy requires thoughtful consideration of the currently available sources of data, their applicability to the prediction of health outcomes, and whether these available data streams are enough to support an actionable decision. This challenge forms the basis of this white paper on how best to reveal potential toxicities of ENDS use in the human cardiovascular system-a primary target of conventional tobacco smoking. We identify current approaches used to evaluate the impacts of tobacco on cardiovascular health, in particular emerging techniques that replace, reduce, and refine slower and more costly animal models with NAMs platforms that can be applied to tobacco regulatory science. The limitations of these emerging platforms are addressed, and systems biology approaches to close the knowledge gap between traditional models and NAMs are proposed. It is hoped that these suggestions and their adoption within the greater scientific community will result in fresh data streams that will support and enhance the scientific evaluation and subsequent decision-making of tobacco regulatory agencies worldwide.
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Affiliation(s)
- Mark Chandy
- Robarts Research Institute, Western University, London, N6A 5K8, Canada
| | - Thomas Hill
- Division of Nonclinical Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Nerea Jimenez-Tellez
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - S Emma Sarles
- Biomedical and Chemical Engineering PhD Program, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Edward Hensel
- Department of Mechanical Engineering, Rochester Institute of Technology, Rochester, NY, 14623, USA
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Daniel J Conklin
- Division of Environmental Medicine, Department of Medicine, Center for Cardiometabolic Science, Christina Lee Brown Envirome Institute, University of Louisville, 580 S. Preston St., Delia Baxter, Rm. 404E, Louisville, KY, 40202, USA.
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Abstract
Wildfire smoke (WFS) is a mixture of respirable particulate matter, environmental gases, and other hazardous pollutants that originate from the unplanned burning of arid vegetation during wildfires. The increasing size and frequency of recent wildfires has escalated public and occupational health concerns regarding WFS inhalation, by either individuals living nearby and downstream an active fire or wildland firefighters and other workers that face unavoidable exposure because of their profession. In this review, we first synthesize current evidence from environmental, controlled, and interventional human exposure studies, to highlight positive associations between WFS inhalation and cardiovascular morbidity and mortality. Motivated by these findings, we discuss preventative measures and suggest interventions to mitigate the cardiovascular impact of wildfires. We then review animal and cell exposure studies to call attention on the pathophysiological processes that support the deterioration of cardiovascular tissues and organs in response to WFS inhalation. Acknowledging the challenges of integrating evidence across independent sources, we contextualize laboratory-scale exposure approaches according to the biological processes that they model and offer suggestions for ensuring relevance to the human condition. Noting that wildfires are significant contributors to ambient air pollution, we compare the biological responses triggered by WFS to those of other harmful pollutants. We also review evidence for how WFS inhalation may trigger mechanisms that have been proposed as mediators of adverse cardiovascular effects upon exposure to air pollution. We finally conclude by highlighting research areas that demand further consideration. Overall, we aspire for this work to serve as a catalyst for regulatory initiatives to mitigate the adverse cardiovascular effects of WFS inhalation in the community and alleviate the occupational risk in wildland firefighters.
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Affiliation(s)
| | | | | | | | - Jessica M. Oakes
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, Boston, MA, USA
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Tao X, Zhang J, Meng Q, Chu J, Zhao R, Liu Y, Dong Y, Xu H, Tian T, Cui J, Zhang L, Chu M. The potential health effects associated with electronic-cigarette. ENVIRONMENTAL RESEARCH 2024; 245:118056. [PMID: 38157958 DOI: 10.1016/j.envres.2023.118056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
A good old gateway theory that electronic-cigarettes (e-cigarettes) are widely recognized as safer tobacco substitutes. In actuality, demographics also show that vaping cannibalizes smoking, the best explanation of the data is the "common liability". However, the utilization of e-cigarette products remains a controversial topic at present. Currently, there has been a widespread and substantial growth in e-cigarette use worldwide owing to their endless new flavors and customizable characteristics. Furthermore, e-cigarette has grown widespread among smokers as well as non-smokers, including adolescents and young adults. And some studies have shown that e-cigarette users are at greater risk to start using combustible cigarettes while e-cigarettes use was also observed the potential benefits to people who want to quit smoking or not. Although it is true that e-cigarettes generally contain fewer toxic substances than combustible cigarettes, this does not mean that the chemical composition in e-cigarettes aerosols poses absolutely no risks. While concerns about toxic substances in e-cigarettes and their widespread use in the population are reasonable, it is also crucial to consider that e-cigarettes have been associated with the potential for promoting smoking cessation and the clinically relevant improvements in users with smoking-related pathologies. Meanwhile, there is still short of understanding of the health impacts associated with e-cigarette use. Therefore, in this review, we discussed the health impacts of e-cigarette exposure on oral, nasal, pulmonary, cardiovascular systems and brain. We aspire for this review to change people's previous perceptions of e-cigarettes and provide them with a more balanced perspective. Additionally, we suggest appropriate adjustments on regulation and policy for e-cigarette to gain greater public health benefits.
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Affiliation(s)
- Xiaobo Tao
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiale Zhang
- The Second People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Qianyao Meng
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, USA
| | - Junfeng Chu
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Rongrong Zhao
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Yiran Liu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yang Dong
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Huiwen Xu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiahua Cui
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Lei Zhang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Minjie Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
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Bantwal P, Kulkarni MM, Kamath VG, Naik AK, Fogarty AW, Dhar M, Ahankari AS. Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002999. [PMID: 38489306 PMCID: PMC10942043 DOI: 10.1371/journal.pgph.0002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/17/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. OBJECTIVES To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. METHODS Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. RESULTS The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. CONCLUSION The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.
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Affiliation(s)
- Priyanka Bantwal
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwath K. Naik
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Andrew W. Fogarty
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Murali Dhar
- Department of Biostatistics and Epidemiology, International Institute for Population Sciences, Mumbai, India
| | - Anand S. Ahankari
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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20
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Glantz SA, Nguyen N, Oliveira da Silva AL. Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes. NEJM EVIDENCE 2024; 3:EVIDoa2300229. [PMID: 38411454 DOI: 10.1056/evidoa2300229] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND: E-cigarettes are promoted as less harmful than cigarettes. There has not been a direct comparison of health effects of e-cigarettes or dual use (concurrently using e-cigarettes and cigarettes) with those of cigarettes in the general population. METHODS: Studies in PubMed, EMBASE, Web of Science, and PsychINFO published through October 1, 2023, were pooled in a random-effects meta-analysis if five or more studies were identified with a disease outcome. We assessed risk of bias with Risk Of Bias In Non-randomized Studies of Exposure and certainty with Grading of Recommendations, Assessment, Development, and Evaluations. Outcomes with fewer studies were summarized but not pooled. RESULTS: We identified 124 odds ratios (94 cross-sectional and 30 longitudinal) from 107 studies. Pooled odds ratios for current e-cigarette versus cigarette use were not different for cardiovascular disease (odds ratio, 0.81; 95% confidence interval, 0.58 to 1.14), stroke (0.73; 0.47 to 1.13), or metabolic dysfunction (0.99; 0.91 to 1.09) but were lower for asthma (0.84; 0.74 to 0.95), chronic obstructive pulmonary disease (0.53; 0.38 to 0.74), and oral disease (0.87; 0.76 to 1.00). Pooled odds ratios for dual use versus cigarettes were increased for all outcomes (range, 1.20 to 1.41). Pooled odds ratios for e-cigarettes and dual use compared with nonuse of either product were increased (e-cigarette range, 1.24 to 1.47; dual use, 1.49 to 3.29). All included studies were assessed as having a low risk of bias. Results were generally not sensitive to study characteristics. Limited studies of other outcomes suggest that e-cigarette use is associated with additional diseases. CONCLUSIONS: There is a need to reassess the assumption that e-cigarette use provides substantial harm reduction across all cigarette-caused diseases, particularly accounting for dual use.
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Affiliation(s)
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco
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21
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Liu T, Zhao H, Wang Y, Qu P, Wang Y, Wu X, Zhao T, Yang L, Mao H, Peng L, Zhan Y, Li P. Serum high mobility group box 1 as a potential biomarker for the progression of kidney disease in patients with type 2 diabetes. Front Immunol 2024; 15:1334109. [PMID: 38481996 PMCID: PMC10932975 DOI: 10.3389/fimmu.2024.1334109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
Background As a damage-associated molecular pattern protein, high mobility group box 1 (HMGB1) is associated with kidney and systemic inflammation. The predictive and therapeutic value of HMGB1 as a biomarker has been confirmed in various diseases. However, its value in diabetic kidney disease (DKD) remains unclear. Therefore, this study aimed to investigate the correlation between serum and urine HMGB1 levels and DKD progression. Methods We recruited 196 patients with type 2 diabetes mellitus (T2DM), including 109 with DKD and 87 T2DM patients without DKD. Additionally, 60 healthy participants without T2DM were also recruited as controls. Serum and urine samples were collected for HMGB1 analysis. Simultaneously, tumor necrosis factor receptor superfamily member 1A (TNFR-1) in serum and kidney injury molecule (KIM-1) in urine samples were evaluated for comparison. Results Serum and urine HMGB1 levels were significantly higher in patients with DKD than in patients with T2DM and healthy controls. Additionally, serum HMGB1 levels significantly and positively correlated with serum TNFR-1 (R 2 = 0.567, p<0.001) and urine KIM-1 levels (R 2 = 0.440, p<0.001), and urine HMGB1 has a similar correlation. In the population with T2DM, the risk of DKD progression increased with an increase in serum HMGB1 levels. Multivariate logistic regression analysis showed that elevated serum HMGB1 level was an independent risk factor for renal function progression in patients with DKD, and regression analysis did not change in the model corrected for multiple variables. The restricted cubic spline depicted a nonlinear relationship between serum HMGB1 and renal function progression in patients with DKD (p-nonlinear=0.007, p<0.001), and this positive effect remained consistent across subgroups. Conclusion Serum HMGB1 was significantly correlated with DKD and disease severity. When the HMGB1 level was ≥27 ng/ml, the risk of renal progression increased sharply, indicating that serum HMGB1 can be used as a potential biomarker for the diagnosis of DKD progression.
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Affiliation(s)
- Tongtong Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hailing Zhao
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Ying Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peng Qu
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Yanmei Wang
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Xiai Wu
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Tingting Zhao
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Liping Yang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huimin Mao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Peng
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
| | - Yongli Zhan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ping Li
- China-Japan Friendship Hospital, Institute of Medical Science, Beijing, China
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Sarkar S, Stitzlein LM, Chandra J. Impact of electronic cigarettes on pediatric, adolescent and young adult leukemia patients. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2024; 7:3. [PMID: 38616981 PMCID: PMC11014418 DOI: 10.21037/pm-23-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Electronic cigarettes, which deliver an aerosolized, nicotine-containing product upon inhalation, are a public health issue that continue to gain popularity among adolescents and young adults in the United States. Use of electronic cigarettes is wide, and extends to pediatric patients with multiple comorbidities, including childhood cancer, leaving them vulnerable to further negative health outcomes. Acute leukemias are the most common type of cancer in pediatric populations, and treatment outcomes for these patients are improving; consequently, there is an increased emphasis on the effect of behavioral lifestyle factors on quality of life in survivorship. The rate of electronic cigarette use is higher among pediatric patients with a history of cancer than those without a history of cancer. Because electronic cigarettes are relatively new, much about their acute and long-term consequences remains unknown, as is their effect on therapy outcomes and long-term survivorship. This review article summarizes current knowledge about electronic cigarettes, including their composition and the trends in use among pediatric patients. Furthermore, this review provides a comprehensive description of the impact electronic cigarettes have on leukemia development, treatment and survivorship and highlights gaps in knowledge that will be necessary for developing recommendations, management strategies, and tailored treatments for pediatric leukemia patients and survivors who use these nicotine products.
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Affiliation(s)
- Sanila Sarkar
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lea M. Stitzlein
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Joya Chandra
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dai W, Shi J, Siddarth P, Carreno J, Kleinman MT, Herman DA, Arechavala RJ, Renusch S, Hasen I, Ting A, Kloner RA. Effects of Electronic Cigarette Vaping on Cardiac and Vascular Function, and Post-myocardial Infarction Remodeling in Rats. Cardiovasc Toxicol 2024; 24:199-208. [PMID: 38340234 PMCID: PMC10896768 DOI: 10.1007/s12012-024-09835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
The effect of electronic cigarette (E-cig) vaping on cardiac and vascular function during the healing phase of myocardial infarction (MI), and post-MI remodeling was investigated. Sprague Dawley rats were subjected to left coronary artery ligation to induce MI. One week later, rats were randomized to receive either 12 weeks of exposure to purified air (n = 37) or E-cig vapor (15 mg/ml of nicotine) (n = 32). At 12 weeks, cardiac and vascular function, and post-MI remodeling were assessed. Baseline blood flow in the femoral artery did not differ between groups, but peak reperfusion blood flow was blunted in the E-cig group (1.59 ± 0.15 ml/min) vs. the air group (2.11 ± 0.18 ml/min; p = 0.034). Femoral artery diameter after reperfusion was narrower in the E-cig group (0.54 ± 0.02 mm) compared to the air group (0.60 ± 0.02 mm; p = 0.023). Postmortem left ventricular (LV) volumes were similar in the E-cig (0.69 ± 0.04 ml) and air groups (0.73 ± 0.04 ml; p = NS); and myocardial infarct expansion index did not differ between groups (1.4 ± 0.1 in E-cig group versus 1.3 ± 0.1 in air group; p = NS). LV fractional shortening by echo did not differ between groups at 12 weeks (E-cig at 29 ± 2% and air at 27 ± 1%; p = NS). Exposure to E-cig during the healing phase of MI was associated with altered vascular function with reduced femoral artery blood flow and diameter at reperfusion, but not with worsened LV dilation or worsened cardiac function.
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Affiliation(s)
- Wangde Dai
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 South Fair Oaks Avenue, Pasadena, CA, 91105, USA.
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA, 90017-2395, USA.
| | - Jianru Shi
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 South Fair Oaks Avenue, Pasadena, CA, 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA, 90017-2395, USA
| | - Prabha Siddarth
- Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, 90095, USA
| | - Juan Carreno
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 South Fair Oaks Avenue, Pasadena, CA, 91105, USA
| | - Michael T Kleinman
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - David A Herman
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Rebecca J Arechavala
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Samantha Renusch
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Irene Hasen
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Amanda Ting
- Department of Environmental and Occupational Health, College of Health Sciences, University of California, Irvine, CA, USA
| | - Robert A Kloner
- HMRI Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 South Fair Oaks Avenue, Pasadena, CA, 91105, USA
- Division of Cardiovascular Medicine of the Keck School of Medicine, University of Southern California, Los Angeles, CA, 90017-2395, USA
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Li D, Xie Z, Shaikh SB, Rahman I. Abnormal expression profile of plasma exosomal microRNAs in exclusive electronic cigarette adult users. RESEARCH SQUARE 2024:rs.3.rs-3877316. [PMID: 38343804 PMCID: PMC10854321 DOI: 10.21203/rs.3.rs-3877316/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Background Exposure to electronic cigarette (e-cigarette) aerosol has been linked to several health concerns, including DNA damage, elevated oxidative stress, the release of inflammatory cytokine, and dysfunctions in epithelial barriers. However, little is known about the effect of exclusive e-cigarette use on expression profiles of exosomal miRNAs, which play critical regulatory roles in many inflammatory responses and disease processes including cancer. We aim to compare the exosomal microRNA expression profile between exclusive e-cigarette users and normal controls without any tobacco product use (non-users). Methods Using plasma samples from 15 exclusive e-cigarette users and 15 non-users in the Population Assessment of Tobacco and Health (PATH) Wave 1 study (2013-2014), we examined exosomal microRNAs expression levels through Illumina NextSeq 500/550 sequencing. The differential analyses between exclusive e-cigarette users and non-users were examined using the generalized linear model approach in the DESeq2 package in R/Bioconductor after adjusting the significant confounding effect from race. Gene enrichment analyses were conducted on target genes regulated by significant microRNAs in the differential analyses. Further, molecular-based techniques using the micro RNA mimics and inhibitors were applied for the validation of the expressions of the micro RNAs in vitro. Results We identified four microRNAs that have significantly higher expression levels in exclusive e-cigarette users than non-users including hsa-miR-100-5p, hsa-miR-125a-5p, hsa-miR-125b-5p, and hsa-miR-99a-5p. GO enrichment analysis on the target genes regulated by the four microRNAs showed that dysregulation of the four microRNAs in exclusive e-cigarette users involved in multiple cell processes such as protein kinase binding and miRNA metabolic process. KEGG pathway enrichment analysis found the four upregulated miRNAs in exclusive e-cigarette users involved in many cancer pathways such as the non-small cell lung cancer, small cell lung cancer, pancreatic cancer, p53 signaling pathway, Hippo signaling pathway, HIF-1 signaling pathway, and MAPK signaling pathway. Overexpression of miRNA hsa-miR-125b-5p was shown to promote DNA damage in bronchial epithelia cells. Conclusions Four plasma exosomal microRNAs involved in cancer development had higher expression levels in exclusive e-cigarette users than non-users, which might indicate a potentially elevated risk of cancer among exclusive e-cigarette users.
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Tungar IM, Rama Krishna Reddy MM, Flores SM, Pokhrel P, Ibrahim AD. The Influence of Lifestyle Factors on the Occurrence and Severity of Premature Ventricular Contractions: A Comprehensive Review. Curr Probl Cardiol 2024; 49:102072. [PMID: 37689374 DOI: 10.1016/j.cpcardiol.2023.102072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Premature ventricular contractions (PVC) are a type of ventricular arrhythmias, occurring as a result of formation or reentry of an abnormal impulse in the ventricular myocardium or in the Purkinje system. PVC occurs commonly in healthy individuals and is observed in 1%-4% of the population. Several lifestyle factors like stress levels, caffeine, drugs, alcohol, nicotine, sleep, and physical exercise have been implicated in increasing the risk. Caffeine and drugs precipitate heightened cardiac stimulation, precipitating PVCs. Excessive alcohol and nicotine disturb the electrical pathways resulting in PVCs. Higher rates of PVCs have been associated with obesity. Individuals with insomnia and increased stress levels are also at an increased risk due to an imbalance in the autonomic system. Exercise is known to induce PVCs, including in healthy, asymptomatic individuals. Modification of these factors can decrease PVC risk. This article aims to provide a comprehensive review of the effects of lifestyle factors on PVC.
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Affiliation(s)
- Ishan M Tungar
- Department of Internal Medicine, B J Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India.
| | | | - Sofia M Flores
- Department of Psychiatry, University of Medicine and Health Sciences, Saint Kitts
| | - Prakriti Pokhrel
- Department of Psychiatry, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
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Meister ML, Feresin RG. Blackberry consumption protects against e-cigarette-induced vascular oxidative stress in mice. Food Funct 2023; 14:10709-10730. [PMID: 37937402 DOI: 10.1039/d3fo02217j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Electronic cigarettes (e-cigarettes) have gained popularity; however, evidence for their safety with chronic use is lacking. Acute e-cigarette exposure induces systemic oxidative stress in users and contributes to vascular endothelial dysfunction through reduction in nitric oxide (NO). Polyphenols, abundant in blackberries (BL), mitigate cardiovascular damage. We aimed to determine whether BL was protective against e-cigarette-induced cardiopulmonary detriments. Mice were fed a diet supplemented with or without 5% freeze-dried BL (w/w) for 16 weeks. E-cigarette exposure (1 h, 5 days per week) began at week 4. Additionally, human microvascular endothelial cells (HMVECs) were treated with BL polyphenol extract (200 μg mL-1) and e-cigarette condensate (0.5% v/v). Twelve weeks of e-cigarette exposure induced multi-organ oxidative stress. E-cigarette exposure increased expression of pro-oxidant enzymes in the endothelium resulting in increased superoxide production diminishing NO bioavailability. Additionally, e-cigarettes reduced the phosphorylation of endothelial NO synthase, contributing to decreases in NO. Mice supplemented with BL were protected against decreases in NO and BL pre-treatment in vitro reduced superoxide production. However, BL was not able to attenuate oxidative stress responses in the heart or lungs. These studies demonstrate the contribution of e-cigarettes to vascular pathologies through an increase in superoxide-producing enzymes and the ability of BL polyphenols to mitigate these deleterious effects in the vasculature. Further studies should explore the role of polyphenol-rich foods in protecting against cardiopulmonary conditions induced by chronic e-cigarette use and explore their use in the recovery period post-e-cigarette cessation to properly align with current public health messaging.
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Affiliation(s)
- Maureen L Meister
- Department of Nutrition, Georgia State University, Atlanta, GA 30302, USA.
- Department of Chemistry, Georgia State University, Atlanta, GA 30302, USA
- Chemical Insights Research Institute, UL Research Institutes, Marietta, GA 30367, USA
| | - Rafaela G Feresin
- Department of Nutrition, Georgia State University, Atlanta, GA 30302, USA.
- Department of Chemistry, Georgia State University, Atlanta, GA 30302, USA
- Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, GA 30302, USA
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Liu J, Nabavizadeh P, Rao P, Derakhshandeh R, Han DD, Guo R, Murphy MB, Cheng J, Schick SF, Springer ML. Impairment of Endothelial Function by Aerosol From Marijuana Leaf Vaporizers. J Am Heart Assoc 2023; 12:e032969. [PMID: 38014661 PMCID: PMC10727338 DOI: 10.1161/jaha.123.032969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Marijuana leaf vaporizers, which heat plant material and sublimate Δ-9-tetrahydrocannabinol without combustion, are popular alternatives to smoking cannabis that are generally perceived to be less harmful. We have shown that smoke from tobacco and marijuana, as well as aerosol from e-cigarettes and heated tobacco products, impair vascular endothelial function in rats measured as arterial flow-mediated dilation (FMD). METHODS AND RESULTS We exposed 8 rats per group to aerosol generated by 2 vaporizer systems (Volcano and handheld Yocan) using marijuana with varying Δ-9-tetrahydrocannabinol levels, in a single pulsatile exposure session of 2 s/min over 5 minutes, and measured changes in FMD. To model secondhand exposure, we exposed rats for 1 minute to diluted aerosol approximating release of uninhaled Volcano aerosol into typical residential rooms. Exposure to aerosol from marijuana with and without cannabinoids impaired FMD by ≈50%. FMD was similarly impaired by aerosols from Yocan (237 °C), and from Volcano at both its standard temperature (185 °C) and the minimum sublimation temperature of Δ-9-tetrahydrocannabinol (157 °C), although the low-temperature aerosol condition did not effectively deliver Δ-9-tetrahydrocannabinol to the circulation. Modeled secondhand exposure based on diluted Volcano aerosol also impaired FMD. FMD was not affected in rats exposed to clean air or water vapor passed through the Volcano system. CONCLUSIONS Acute direct exposure and modeled secondhand exposure to marijuana leaf vaporizer aerosol, regardless of cannabinoid concentration or aerosol generation temperature, impair endothelial function in rats comparably to marijuana smoke. Our findings indicate that use of leaf vaporizers is unlikely to reduce the vascular risk burden of smoking marijuana.
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Affiliation(s)
- Jiangtao Liu
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pooneh Nabavizadeh
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Present address:
Division of CardiologyUniversity of CincinnatiCincinnatiOHUSA
| | - Poonam Rao
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Christus Good Shepherd/Texas A&M University Internal Medicine Residency ProgramLongviewTXUSA
| | - Ronak Derakhshandeh
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Daniel D. Han
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
School of Medicine and DentistryUniversity of RochesterRochesterNYUSA
| | - Raymond Guo
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Stanford UniversityStanfordCAUSA
| | - Morgan B. Murphy
- Division of Occupational and Environmental MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
- Present address:
Sutter Health California Pacific Medical CenterStanfordCAUSA
| | - Jing Cheng
- Division of Oral Epidemiology and Dental Public HealthUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Suzaynn F. Schick
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
- Division of Occupational and Environmental MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Matthew L. Springer
- Cardiovascular Research Institute, University of California, San FranciscoSan FranciscoCAUSA
- Division of CardiologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
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Han DD, Rao P, Qiu H, Navabzadeh M, Wang X, Goyal N, Mohammadi L, Huang A, Perez BG, Schick SF, Springer ML. Impairment of Endothelial Function by Cigarette Smoke and e-Cigarette Aerosol Requires RAGE. Arterioscler Thromb Vasc Biol 2023; 43:2369-2371. [PMID: 37795616 PMCID: PMC10841038 DOI: 10.1161/atvbaha.123.319514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Daniel D. Han
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Present address: School of Medicine & Dentistry, University of Rochester, Rochester, NY
| | - Poonam Rao
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
- Present address: CHRISTUS Good Shepherd/Texas A&M University Internal Medicine Residency Program, Longview, TX
| | - Huiliang Qiu
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Present address: Department of Cardiovascular Diseases, Physiology and Biomedical Engineering, Mayo Clinic Arizona, Scottsdale, AZ
| | - Mina Navabzadeh
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Xiaoyin Wang
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Natasha Goyal
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Leila Mohammadi
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Abel Huang
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Bryanna G. Perez
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Suzaynn F. Schick
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Matthew L. Springer
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA
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Higashi Y. Smoking cessation and vascular endothelial function. Hypertens Res 2023; 46:2670-2678. [PMID: 37828134 PMCID: PMC10695829 DOI: 10.1038/s41440-023-01455-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
Smoking is associated with vascular endothelial dysfunction. It is thought that smoking impairs vascular endothelial function through a decrease in nitric oxide bioavailability induced by activation of oxidative stress and inflammation. Endothelial dysfunction can be improved or augmented by appropriate interventions including pharmacotherapy, administration of supplements and lifestyle modifications. Although there have not been many studies, the effects of smoking cessation on endothelial function have been shown. In those studies, it was shown that smoking cessation does not always have a positive effect on vascular endothelial function. In this review, I will focus on the role of smoking in endothelial function and the effects of smoking cessation on endothelial function. Smoking impairs vascular endothelial function and leads to atherosclerosis. Smoking cessation is expected to improve vascular endothelial function. Effects of smoking cessation on endothelial function are not always consistent. Further studies are needed to determine whether smoking cessation directly improves endothelial function. NO indicates nitric oxide.
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Affiliation(s)
- Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
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Wang E, Andrade MJ, Smith Q. Vascularized liver-on-a-chip model to investigate nicotine-induced dysfunction. BIOMICROFLUIDICS 2023; 17:064108. [PMID: 38155919 PMCID: PMC10754629 DOI: 10.1063/5.0172677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023]
Abstract
The development of physiologically relevant in vitro systems for simulating disease onset and progression and predicting drug metabolism holds tremendous value in reducing drug discovery time and cost. However, many of these platforms lack accuracy in replicating the tissue architecture and multicellular interactions. By leveraging three-dimensional cell culture, biomimetic soft hydrogels, and engineered stimuli, in vitro models have continued to progress. Nonetheless, the incorporation of the microvasculature has been met with many challenges, specifically with the addition of parenchymal cell types. Here, a systematic approach to investigating the initial seeding density of endothelial cells and its effects on interconnected networks was taken and combined with hepatic spheroids to form a liver-on-a-chip model. Leveraging this system, nicotine's effects on microvasculature and hepatic function were investigated. The findings indicated that nicotine led to interrupted adherens junctions, decreased guanosine triphosphate cyclohydrolase 1 expression, impaired angiogenesis, and lowered barrier function, all key factors in endothelial dysfunction. With the combination of the optimized microvascular networks, a vascularized liver-on-a-chip was formed, providing functional xenobiotic metabolism and synthesis of both albumin and urea. This system provides insight into potential hepatotoxicity caused by various drugs and allows for assessing vascular dysfunction in a high throughput manner.
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Affiliation(s)
- Eric Wang
- Department of Chemical and Biomolecular Engineering, University of California Irvine, Irvine, California 92697, USA
| | - Melisa J. Andrade
- Department of Chemical and Biomolecular Engineering, University of California Irvine, Irvine, California 92697, USA
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31
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Halstead KM, Wetzel EM, Cho JL, Stanhewicz AE. Sex Differences in Oxidative Stress-Mediated Reductions in Microvascular Endothelial Function in Young Adult e-Cigarette Users. Hypertension 2023; 80:2641-2649. [PMID: 37800370 PMCID: PMC10848654 DOI: 10.1161/hypertensionaha.123.21684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Chronic electronic-cigarette (EC) use is reported to decrease vascular endothelial function. However, the mechanism(s) mediating this reduction remain unclear. In this study, we examined endothelium- and NO-dependent dilation, and the role of oxidative stress in attenuating these responses, in healthy young EC users (n=20, 10 males/10 females) compared with healthy controls (n=20, 10 males/10 females). We hypothesized that EC would have reduced endothelium- and NO-dependent dilation and administration of the superoxide scavenger tempol would increase these responses in EC. We further hypothesized that female EC would have the greatest reductions in endothelium- and NO-dependent dilation. METHODS We assessed microvascular endothelium-dependent vasodilator function in vivo by measurement of cutaneous vascular conductance (%CVCmax) responses to a standardized local heating protocol in control and 10 μM tempol-treated sites. After full expression of the local heating response, 15 mM NG-nitro-L-arginine methyl ester (NO synthase inhibition) was perfused. RESULTS EC had significantly reduced endothelium- (73±15 versus 87±9%CVCmax; P<0.001) and NO-dependent (48±17% versus 62±15%; P=0.011) dilation. Tempol perfusion increased endothelium-dependent (84±12%CVCmax P=0.01) and NO-dependent (63±14% P=0.005) dilation in EC but had no effect in healthy control. Within female sex, EC had lower endothelium-dependent (71±13 versus 89±7%CVCmax; P=0.002) and NO-dependent (50±6 versus 69±11%; P=0.005) dilation compared with healthy control, and tempol augmented endothelium-dependent (83±13%CVCmax; P=0.002) and NO-dependent (62±13%; P=0.015) dilation. There were no group or treatment differences within male sex. CONCLUSION Healthy young adult EC users have reduced microvascular endothelium-dependent and NO-dependent dilation, driven by greater reductions in female EC users, and mediated in part by superoxide.
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Affiliation(s)
- Kristen M Halstead
- Department of Health and Human Physiology, The University of Iowa, Iowa City, IA (K.M.H., E.M.W., A.E.S.)
| | - Elizabeth M Wetzel
- Department of Health and Human Physiology, The University of Iowa, Iowa City, IA (K.M.H., E.M.W., A.E.S.)
| | - Josalyn L Cho
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA (J.L.C.)
| | - Anna E Stanhewicz
- Department of Health and Human Physiology, The University of Iowa, Iowa City, IA (K.M.H., E.M.W., A.E.S.)
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Hamann SL, Kungskulniti N, Charoenca N, Kasemsup V, Ruangkanchanasetr S, Jongkhajornpong P. Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6808. [PMID: 37835078 PMCID: PMC10572885 DOI: 10.3390/ijerph20196808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023]
Abstract
Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.
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Affiliation(s)
- Stephen L. Hamann
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Nipapun Kungskulniti
- Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
- Thailand Health Promotion Institute, Bangkok 10330, Thailand
| | - Naowarut Charoenca
- Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
- Thailand Health Promotion Institute, Bangkok 10330, Thailand
| | - Vijj Kasemsup
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Suwanna Ruangkanchanasetr
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
| | - Passara Jongkhajornpong
- Tobacco Control Research and Knowledge Management Center, Bangkok 10400, Thailand; (S.L.H.); (V.K.); (S.R.); (P.J.)
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Wölkart G, Kollau A, Russwurm M, Koesling D, Schrammel A, Mayer B. Varied effects of tobacco smoke and e-cigarette vapor suggest that nicotine does not affect endothelium-dependent relaxation and nitric oxide signaling. Sci Rep 2023; 13:15833. [PMID: 37739972 PMCID: PMC10517138 DOI: 10.1038/s41598-023-42750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
Chronic smoking causes dysfunction of vascular endothelial cells, evident as a reduction of flow-mediated dilation in smokers, but the role of nicotine is still controversial. Given the increasing use of e-cigarettes and other nicotine products, it appears essential to clarify this issue. We studied extracts from cigarette smoke (CSE) and vapor from e-cigarettes (EVE) and heated tobacco (HTE) for their effects on vascular relaxation, endothelial nitric oxide signaling, and the activity of soluble guanylyl cyclase. The average nicotine concentrations of CSE, EVE, and HTE were 164, 800, and 85 µM, respectively. At a dilution of 1:3, CSE almost entirely inhibited the relaxation of rat aortas and porcine coronary arteries to acetylcholine and bradykinin, respectively, while undiluted EVE, with a 15-fold higher nicotine concentration, had no significant effect. With about 50% inhibition at 1:2 dilution, the effect of HTE was between CSE and EVE. Neither extract affected endothelium-independent relaxation to an NO donor. At the dilutions tested, CSE was not toxic to cultured endothelial cells but, in contrast to EVE, impaired NO signaling and inhibited NO stimulation of soluble guanylyl cyclase. Our results demonstrate that nicotine does not mediate the impaired endothelium-dependent vascular relaxation caused by smoking.
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Affiliation(s)
- Gerald Wölkart
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Alexander Kollau
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Michael Russwurm
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Doris Koesling
- Department of Pharmacology and Toxicology, Ruhr-Universität Bochum, MA N1-39, 44780, Bochum, Germany
| | - Astrid Schrammel
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria
| | - Bernd Mayer
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Universität Graz, Humboldtstraße 46, 8010, Graz, Austria.
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Mills A, Frazier J, Plants R, Burrage E, Coblentz T, Nassabeh S, Robinson M, Chantler PD, Olfert IM. Effects of electronic cigarette E-liquid and device wattage on vascular function. Toxicol Appl Pharmacol 2023; 474:116631. [PMID: 37468077 PMCID: PMC10534201 DOI: 10.1016/j.taap.2023.116631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
Electronic cigarettes (e-cigs) are customizable tobacco products that allow users to select e-liquid composition, flavors, and (in some devices) adjust wattage or heat used to generate e-cig aerosol. This study compared vascular outcomes in a conducting vessel (thoracic aorta) and a resistance artery (middle cerebral artery, MCA) in C57Bl/6 mice exposed to e-cig aerosol generated from either pure vegetable glycerin (VG) or pure propylene glycol (PG) over 60-min (Study 1), and separately the effect of using 5- vs. 30-watt settings with an exposure of 100-min (Study 2). In Study 1, aortic endothelial-dependent-dilation (EDD) was only impaired with PG- exposure (p < 0.05) compared with air. In the MCA, EDD response was impaired by ∼50% in both VG and PG groups compared with air (p < 0.05). In Study 2, the aortic EDD responses were not different for either 5- or 30-watt exposed groups compared with air controls; however, in the MCA, both 5- and 30-watt groups were impaired by 32% and 55%, respectively, compared with air controls (p < 0.05). These pre-clinical data provide evidence that chronic exposure to aerosol produced by either VG or PG, and regardless of the wattage used, leads to vascular dysfunction at multiple levels within the arterial system. For all exposures, we observed greater impairment of arterial reactivity in a resistance artery (i.e. MCA) compared with the aorta. These data could suggest the smaller arteries may be more sensitive or first to be affected, or that different mechanism(s) for impairment may be involved depending on arterial hierarchy.
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Affiliation(s)
- Amber Mills
- Department of Physiology, Pharmacology and Toxicology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America; Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - James Frazier
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Rachel Plants
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Emily Burrage
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Tyler Coblentz
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Sydney Nassabeh
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Madison Robinson
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - Paul D Chantler
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America; Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America
| | - I Mark Olfert
- Department of Physiology, Pharmacology and Toxicology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America; Center for Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America; Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, WV 26506, United States of America.
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35
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Diaz MC, Silver NA, Bertrand A, Schillo BA. Bigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices. Tob Control 2023:tc-2023-058033. [PMID: 37536928 DOI: 10.1136/tc-2023-058033] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Given the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both e-cigarette unit and volume of e-liquid. METHODOLOGY We used NielsenIQ retail scanner data from January 2017 to September 2022 to examine changes over time for average product volume capacity in millilitres, nicotine strength (%) and both sales-weighted average price per disposable unit and per millilitre of e-liquid for each 4-week period. RESULTS Among disposable e-cigarettes sold between January 2017 and September 2022, average volume capacity increased 518% from 1.1 mL to 5.7 mL and average nicotine strength increased 294% from 1.7% to 5%. Sales-weighted average price per disposable unit and millilitres of e-liquid both remained relatively constant until January 2020. From January 2020 through September 2022, average unit prices increased 165.7% from US$8.49 to US$14.07, while the average price of 1 mL of e-liquid decreased 69.2% from US$7.96 to US$2.45. CONCLUSIONS The current regulatory regime around e-cigarettes has resulted in disposable e-cigarette manufacturers providing consumers with bigger, cheaper disposable e-cigarettes that come in increasingly higher nicotine strengths. Tobacco policy recommendations such as restricting e-liquid capacity and minimum price laws as well as regulations on product characteristics that affect nicotine emissions and delivery such as nicotine strength, nicotine output, device power, and puff duration should be considered in regulating the e-cigarette market.
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Affiliation(s)
- Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
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Lyytinen G, Brynedal A, Anesäter E, Antoniewicz L, Blomberg A, Wallén H, Bosson JA, Hedman L, Mobarrez F, Tehrani S, Lundbäck M. Electronic Cigarette Vaping with Nicotine Causes Increased Thrombogenicity and Impaired Microvascular Function in Healthy Volunteers: A Randomised Clinical Trial. Cardiovasc Toxicol 2023; 23:255-264. [PMID: 37548804 PMCID: PMC10435650 DOI: 10.1007/s12012-023-09802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/15/2023] [Indexed: 08/08/2023]
Abstract
Electronic cigarette (EC) vaping is increasingly popular, despite growing evidence of adverse health effects. To further evaluate the impact of EC use on vascular health, we investigated the effects of brief EC inhalation on flow-dependent thrombus formation and microcirculation in healthy volunteers. The study was performed with a randomised double-blind crossover design. Twenty-two healthy subjects aged between 18 and 45 years with occasional tobacco use were recruited. Subjects inhaled 30 puffs of EC aerosol with and without nicotine on two occasions separated by a wash-out period of at least 1 week. Blood samples were collected at baseline and at 15 and 60 min following exposure and analysed with the Total-Thrombus-formation analysis system evaluating fibrin-rich thrombus formation and platelet thrombus formation in whole blood under flow. Microvascular function was assessed at baseline and 30 min after exposure by laser speckle contrast imaging and iontophoresis of acetylcholine and sodium nitroprusside (SNP) to evaluate the endothelium-dependent and independent pathways of vasodilation. Compared with nicotine free EC aerosol, exposure to EC aerosol with nicotine significantly increased platelet thrombus formation and fibrin-rich thrombus formation at 15 min (p = 0.017 and p = 0.037, respectively) with normalisation after 60 min. Peak SNP-mediated microvascular perfusion, i.e. endothelium-independent vasodilation, was reduced following EC vaping with nicotine compared with baseline (p = 0.006). Thirty puffs of EC aerosol with nicotine increased platelet and fibrin-dependent thrombus formation and reduced microvascular dilatation capacity. No compelling effects of EC vaping without nicotine were observed, indicating nicotine as the main effector. Trial registration: ClinicalTrials.gov Identifier: NCT04175457 URL: https://clinicaltrials.gov/ct2/show/NCT04175457.
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Affiliation(s)
- Gustaf Lyytinen
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
| | - Amelie Brynedal
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Erik Anesäter
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Lukasz Antoniewicz
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Anders Blomberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Jenny A Bosson
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | | | - Sara Tehrani
- Department of Clinical Sciences, Division of Internal Medicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lundbäck
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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Cardenas HL, Evanoff NG, Fandl HK, Berry AR, Wegerson KN, Ostrander EI, Greiner JJ, Dufresne SR, Kotlyar M, Dengel DR, DeSouza CA, Garcia VP. Endothelial-derived extracellular vesicles associated with electronic cigarette use impair cerebral microvascular cell function. J Appl Physiol (1985) 2023; 135:271-278. [PMID: 37348012 PMCID: PMC10393369 DOI: 10.1152/japplphysiol.00243.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
The aim of this study was to determine the effect of circulating endothelial cell-derived microvesicles (EMVs) isolated from e-cigarette users on human cerebral microvascular endothelial cells (hCMECs) nitric oxide (NO) and endothelin (ET)-1 production and tissue-type plasminogen activator (t-PA) release. Circulating EMVs (CD144-PE) were isolated (flow cytometry) from 27 young adults (19-25 yr): 10 nonsmokers (6 M/4 F), 10 e-cigarette users (6 M/4 F), and 7 tobacco cigarette smokers (4 M/3 F). hCMECs were cultured and treated with isolated EMVs for 24 h. EMVs from e-cigarette users and cigarette smokers induced significantly higher expression of p-eNOS (Thr495; 28.4 ± 4.6 vs. 29.1 ± 2.8 vs. 22.9 ± 3.8 AU), Big ET-1 (138.8 ± 19.0 vs. 141.7 ± 19.1 vs. 90.3 ± 18.8 AU) and endothelin converting enzyme (107.6 ± 10.1 and 113.5 ± 11.8 vs. 86.5 ± 13.2 AU), and significantly lower expression of p-eNOS (Ser1177; 7.4 ± 1.7 vs. 6.5 ± 0.5 vs. 9.7 ± 1.6 AU) in hCMECs than EMVs from nonsmokers. NO production was significantly lower and ET-1 production was significantly higher in hCMECs treated with EMVs from e-cigarette (5.7 ± 0.8 µmol/L; 33.1 ± 2.9 pg/mL) and cigarette smokers (6.3 ± 0.7 µmol/L; 32.1 ± 3.9 pg/mL) than EMVs from nonsmokers (7.6 ± 1.2 µmol/L; 27.9 ± 3.1 pg/mL). t-PA release in response to thrombin was significantly lower in hCMECs treated with EMVs from e-cigarette users (from 38.8 ± 6.3 to 37.4 ± 8.3 pg/mL) and cigarette smokers (31.5 ± 5.5 to 34.6 ± 8.4 pg/mL) than EMVs from nonsmokers (38.9 ± 4.3 to 48.4 ± 7.9 pg/mL). There were no significant differences in NO, ET-1, or t-PA protein expression or production in hCMECs treated with EMVs from e-cigarette users and smokers. Circulating EMVs associated with e-cigarette use adversely affects brain microvascular endothelial cells and may contribute to reported cerebrovascular dysfunction with e-cigarette use.NEW & NOTEWORTHY In the present study, we determined the effect of circulating endothelial cell-derived microvesicles (EMVs) isolated from e-cigarette users on human cerebral microvascular endothelial cells (hCMECs) nitric oxide (NO) and endothelin (ET)-1 production and tissue-type plasminogen activator (t-PA) release. EMVs from e-cigarette users reduced brain microvascular endothelial cell NO production, enhanced ET-1 production, and impaired endothelial t-PA release. EMVs are a potential mediating factor in the increased risk of stroke associated with e-cigarette use.
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Affiliation(s)
- Hannah L Cardenas
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Nicholas G Evanoff
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Hannah K Fandl
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Auburn R Berry
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kendra N Wegerson
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Emily I Ostrander
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sheena R Dufresne
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Vinicius P Garcia
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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Tattersall MC, Esnault S, Stewart R, Vereide DT, Swanson S, Zhang J, Steill J, Jarjour N, Hansen KM, Korcarz CE, Baker TB, Stein JH. Effects of an In Vivo Vaping Challenge on In Vitro Interleukin-6 Biosynthesis Pathways in Arterial Endothelial Cells Derived From Human Embryonic Stem Cells. J Am Heart Assoc 2023:e030139. [PMID: 37449574 PMCID: PMC10382107 DOI: 10.1161/jaha.123.030139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Madison WI
| | - Stephane Esnault
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine The University of Wisconsin-Madison School of Medicine and Public Health Madison WI
| | | | | | | | - Jue Zhang
- Morgridge Institute for Research Madison WI
| | | | - Nizar Jarjour
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine The University of Wisconsin-Madison School of Medicine and Public Health Madison WI
| | - Kristin M Hansen
- Department of Medicine, Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Madison WI
| | - Claudia E Korcarz
- Department of Medicine, Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Madison WI
| | - Timothy B Baker
- University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) University of Wisconsin School of Medicine and Public Health Madison WI
| | - James H Stein
- Department of Medicine, Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Madison WI
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Fountoulakis P, Theofilis P, Tsalamandris S, Antonopoulos AS, Tsioufis P, Toutouzas K, Oikonomou E, Tsioufis K, Tousoulis D. The cardiovascular consequences of electronic cigarette smoking: a narrative review. Expert Rev Cardiovasc Ther 2023; 21:651-661. [PMID: 37755116 DOI: 10.1080/14779072.2023.2264179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION E-cigarettes have emerged as a popular alternative to traditional tobacco smoking in recent years. Despite their growing popularity, concerns have arisen regarding the cardiovascular implications of e-cigarette use. AREAS COVERED This narrative review aims to highlight the latest evidence on the impact of e-cigarettes on cardiovascular health. EXPERT OPINION Numerous studies have demonstrated that e-cigarette use can lead to acute adverse cardiovascular effects. Inhalation of e-cigarette aerosols exposes users to a wide range of potentially harmful substances that have been implicated in critical pathophysiologic pathways of cardiovascular disease, namely endothelial dysfunction, oxidative stress, inflammation, sympathetic overdrive, and arterial stiffness. While long-term epidemiological studies specifically focusing on the cardiovascular effects of e-cigarettes are still relatively scarce, early evidence suggests a potential association between e-cigarette use and an increased risk of adverse cardiovascular events. However, it is essential to recognize that e-cigarettes are relatively new products, and the full extent of their long-term cardiovascular impact has not been fully elucidated. In the meantime, promoting tobacco cessation strategies that are evidence-based and regulated, along with rigorous monitoring of e-cigarette use patterns and associated health outcomes, are essential steps in safeguarding cardiovascular health in the face of this emerging public health challenge.
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Affiliation(s)
- Petros Fountoulakis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Theofilis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Sotiris Tsalamandris
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Toutouzas
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
- Cardiology Department, Sotiria Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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Boakye E, Uddin SMI, Osuji N, Meinert J, Obisesan OH, Mirbolouk M, Tasdighi E, El-Shahawy O, Erhabor J, Osei AD, Rajan T, Patatanian M, Holbrook JT, Bhatnagar A, Biswal SS, Blaha MJ. Examining the association of habitual e-cigarette use with inflammation and endothelial dysfunction in young adults: The VAPORS-Endothelial function study. Tob Induc Dis 2023; 21:75. [PMID: 37305426 PMCID: PMC10257221 DOI: 10.18332/tid/162327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION Acute exposure to e-cigarette aerosol has been shown to have potentially deleterious effects on the cardiovascular system. However, the cardiovascular effects of habitual e-cigarette use have not been fully elucidated. Therefore, we aimed to assess the association of habitual e-cigarette use with endothelial dysfunction and inflammation - subclinical markers known to be associated with increased cardiovascular risk. METHODS In this cross-sectional study, we analyzed data from 46 participants (23 exclusive e-cigarette users; 23 non-users) enrolled in the VAPORS-Endothelial function study. E-cigarette users had used e-cigarettes for ≥6 consecutive months. Non-users had used e-cigarettes <5 times and had a negative urine cotinine test (<30 ng/mL). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were used to assess endothelial dysfunction, and we assayed high-sensitivity C-reactive protein, interleukin-6, fibrinogen, p-selectin, and myeloperoxidase as serum measures of inflammation. We used multivariable linear regression to assess the association of e-cigarette use with the markers of endothelial dysfunction and inflammation. RESULTS Of the 46 participants with mean age of 24.3 ± 4.0 years, the majority were males (78%), non-Hispanic (89%), and White (59%). Among non-users, 6 had cotinine levels <10 ng/mL while 17 had levels 10-30 ng/mL. Conversely, among e-cigarette users, the majority (14 of 23) had cotinine ≥500 ng/mL. At baseline, the systolic blood pressure was higher among e-cigarette users than non-users (p=0.011). The mean FMD was slightly lower among e-cigarette users (6.32%) compared to non-users (6.53%). However, in the adjusted analysis, current e-cigarette users did not differ significantly from non-users in their mean FMD (Coefficient=2.05; 95% CI: -2.52-6.63) or RHI (Coefficient= -0.20; 95% CI: -0.88-0.49). Similarly, the levels of inflammatory markers were generally low and did not differ between e-cigarette users and non-users. CONCLUSIONS Our findings suggest that e-cigarette use may not be significantly associated with endothelial dysfunction and systemic inflammation in relatively young and healthy individuals. Longer term studies with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Ellen Boakye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
| | - S. M. Iftekhar Uddin
- Department of Medicine, Brookdale University Hospital Medical Center, New York City, United States
| | - Ngozi Osuji
- Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, United States
| | - Jill Meinert
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | | | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Erfan Tasdighi
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Omar El-Shahawy
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, United States
| | - John Erhabor
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
| | - Albert D. Osei
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, United States
| | - Tanuja Rajan
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
| | - Michael Patatanian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Janet T. Holbrook
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
- Department of Medicine, University of Louisville School of Medicine, Louisville, United States
| | - Shyam S. Biswal
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University, Baltimore, United States
- The American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Dallas, United States
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Klein J, Diaba-Nuhoho P, Giebe S, Brunssen C, Morawietz H. Regulation of endothelial function by cigarette smoke and next-generation tobacco and nicotine products. Pflugers Arch 2023:10.1007/s00424-023-02824-w. [PMID: 37285061 DOI: 10.1007/s00424-023-02824-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Cigarette smoking is the most important avoidable cardiovascular risk factor. It causes endothelial dysfunction and atherosclerosis and increases the risk of its severe clinical complications like coronary artery disease, myocardial infarction, stroke, and peripheral artery disease. Several next-generation tobacco and nicotine products have been developed to decrease some of the deleterious effects of regular tobacco smoking. This review article summarizes recent findings about the impact of cigarette smoking and next-generation tobacco and nicotine products on endothelial dysfunction. Both cigarette smoking and next-generation tobacco products lead to impaired endothelial function. Molecular mechanisms of endothelial dysfunction like oxidative stress, reduced nitric oxide availability, inflammation, increased monocyte adhesion, and cytotoxic effects of cigarette smoke and next-generation tobacco and nicotine products are highlighted. The potential impact of short- and long-term exposure to next-generation tobacco and nicotine products on the development of endothelial dysfunction and its clinical implications for cardiovascular diseases are discussed.
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Affiliation(s)
- Justus Klein
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Patrick Diaba-Nuhoho
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
- Department of Paediatric and Adolescent Medicine, Paediatric Haematology and Oncology, University Hospital Münster, Albert-Schweitzer-Str. 33, D-48149, Münster, Germany
| | - Sindy Giebe
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Coy Brunssen
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Henning Morawietz
- Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Faculty of Medicine, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology, Fetscherstr. 74, D-01307, Dresden, Germany.
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Golub A, Ordak M, Nasierowski T, Bujalska-Zadrozny M. Advanced Biomarkers of Hepatotoxicity in Psychiatry: A Narrative Review and Recommendations for New Psychoactive Substances. Int J Mol Sci 2023; 24:ijms24119413. [PMID: 37298365 DOI: 10.3390/ijms24119413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
One of the factors that increase the effectiveness of the pharmacotherapy used in patients abusing various types of new psychoactive substances (NPSs) is the proper functioning of the liver. However, the articles published to date on NPS hepatotoxicity only address non-specific hepatic parameters. The aim of this manuscript was to review three advanced markers of hepatotoxicity in psychiatry, namely, osteopontin (OPN), high-mobility group box 1 protein (HMGB1) and glutathione dehydrogenase (GDH, GLDH), and, on this basis, to identify recommendations that should be included in future studies in patients abusing NPSs. This will make it possible to determine whether NPSs do indeed have a hepatotoxic effect or whether other factors, such as additional substances taken or hepatitis C virus (HCV) infection, are responsible. NPS abusers are at particular risk of HCV infection, and for this reason, it is all the more important to determine what factors actually show a hepatotoxic effect in them.
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Affiliation(s)
- Aniela Golub
- Department of Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1 Str., 02-097 Warsaw, Poland
| | - Michal Ordak
- Department of Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1 Str., 02-097 Warsaw, Poland
| | - Tadeusz Nasierowski
- Department of Psychiatry, Faculty of Pharmacy, Medical University of Warsaw, Nowowiejska 27 Str., 00-665 Warsaw, Poland
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1 Str., 02-097 Warsaw, Poland
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Behrooz L, Abumoawad A, Rizvi SHM, Hamburg NM. A modern day perspective on smoking in peripheral artery disease. Front Cardiovasc Med 2023; 10:1154708. [PMID: 37187787 PMCID: PMC10175606 DOI: 10.3389/fcvm.2023.1154708] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Peripheral artery disease (PAD) is associated with increased risk of cardiovascular morbidity and mortality, poor functional status, and lower quality of life. Cigarette smoking is a major preventable risk factor for PAD and is strongly associated with a higher risk of disease progression, worse post-procedural outcomes, and increased healthcare utilization. The arterial narrowing due to atherosclerotic lesions in PAD leads to decreased perfusion to the limbs and can ultimately cause arterial obstruction and limb ischemia. Endothelial cell dysfunction, oxidative stress, inflammation, and arterial stiffness are among the key events during the development of atherogenesis. In this review, we discuss the benefits of smoking cessation among patients with PAD and the use of smoking cessation methods including pharmacological treatment. Given that smoking cessation interventions remain underutilized, we highlight the importance of incorporating smoking cessation treatments as part of the medical management of patients with PAD. Regulatory approaches to reduce the uptake of tobacco product use and support smoking cessation have the potential to reduce the burden of PAD.
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Affiliation(s)
- Leili Behrooz
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Abdelrhman Abumoawad
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Syed Husain M. Rizvi
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Naomi M. Hamburg
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Daiber A, Kuntic M, Oelze M, Hahad O, Münzel T. E-cigarette effects on vascular function in animals and humans. Pflugers Arch 2023:10.1007/s00424-023-02813-z. [PMID: 37084087 DOI: 10.1007/s00424-023-02813-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
Smoking tobacco cigarettes is a significant (cardiovascular) health risk factor. Although the number of tobacco cigarette users declined over the last decades, shisha smoking and e-cigarette vaping partially compensated for this health benefit. E-cigarettes may create highly addicted dual users (vaping and smoking). E-cigarettes seem not to represent a healthier alternative to tobacco smoking, although they may be less harmful. E-cigarette vaping causes oxidative stress, inflammation, endothelial dysfunction, and associated cardiovascular sequelae. This is primarily due to a significant overlap of toxic compounds in the vapor compared to tobacco smoke and, accordingly, a substantial overlap of pathomechanistic features between vaping and smoking. Whereas the main toxins in vapor are reactive aldehydes such as formaldehyde and acrolein, the toxic mixture in smoke is more complex, comprising particulate matter, reactive gases, transition metals, volatile organic compounds, and N-nitrosamines. However, it seems that both lifestyle drugs impair endothelial function to a quite similar extent, which may be due to the role of oxidative stress as the central pathomechanism to mediate endothelial dysfunction and vascular damage. Finally, the main selling argument for e-cigarette use that they help to quit smoking and get rid of nicotine addiction may be false because it seems that e-cigarettes instead trigger the opposite-younger entrance age and more frequent use. With our review, we summarize the adverse health impact of tobacco cigarettes and e-cigarettes, emphasizing the detrimental effects on endothelial function and cardiovascular health.
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Affiliation(s)
- Andreas Daiber
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
| | - Marin Kuntic
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Matthias Oelze
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology 1, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Rhine-Main, Mainz, Germany.
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Ashour O, Al-Huneidy L, Noordeen H. The implications of vaping on surgical wound healing: A systematic review. Surgery 2023; 173:1452-1462. [PMID: 36997424 DOI: 10.1016/j.surg.2023.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND E-cigarette use is rapidly growing, and little is known about the postoperative complications. Cigarette smoking has been well-established to be associated with delayed wound healing and increased complications in surgical patients. Due to the intricate and harmonious nature of the wound-healing process, vaping may impair tissue regeneration, posing a risk for patients undergoing surgery. This systematic review aimed to review the evidence on the implications of vaping on wound healing. METHODS A systematic search of PubMed and Scopus databases was conducted on October 2022 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following keywords were used to conduct the search: vaping, vape, e-cigarettes, electronic cigarettes, wound healing, tissue regeneration, postoperative complications, wound infection, and blood flow. RESULTS Of 5,265 screened articles, only 37 were eligible for qualitative synthesis. A total of 18 articles studied the effect of e-cigarettes on human volunteers, 14 investigated e-cigarette extract on human cell lines, and 5 used animal rat models. CONCLUSION Despite limited objective data, the recommendation is that e-cigarettes be treated as tobacco cigarettes; hence, vaping should be stopped in the perioperative period to decrease the incidence of wound healing complications. Clinical trials are required to understand the health hazards of e-cigarettes further and maximize patient safety and clinical outcomes.
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Elektrische Zigaretten – Stand der Forschung aus gefäßmedizinischer Sicht. GEFÄSSCHIRURGIE 2023. [DOI: 10.1007/s00772-023-00974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Aboaziza E, Feaster K, Hare L, Chantler PD, Olfert IM. Maternal electronic cigarette use during pregnancy affects long-term arterial function in offspring. J Appl Physiol (1985) 2023; 134:59-71. [PMID: 36417201 PMCID: PMC9762967 DOI: 10.1152/japplphysiol.00582.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
Vaping, or electronic cigarette (ecig) use, is prevalent among pregnant women, although little is known about the effects of perinatal ecig use on cardiovascular health of the progeny (even when using nicotine-free e-liquid). Maternal toxicant inhalation may adversely affect vital conduit vessel development. We tested the hypothesis that perinatal exposure to maternal vaping would lead to a dose-dependent dysfunction that would persist into later life of offspring. Pregnant Sprague-Dawley rats were exposed to either nicotine-free (ecig0) or nicotine-containing ecig aerosol (18 mg/mL, ecig18) starting on gestational day 2 and continued until pups were weaned (postnatal day 21). Pups were never directly exposed. Conduit artery function (stiffness and reactivity) and structure were assessed in 3- and 7-mo-old offspring. At 3 mo, pulse wave velocity (PWV) in the ecig0 and ecig18 offspring was significantly higher than controls in both the 20 puffs/day (6.6 ± 2.1 and 4.8 ± 1.3 vs. 3.2 ± 0.7 m/s, respectively, P < 0.05, means ± SD) and in 60 puffs/day exposure cohort (7.5 ± 2.8 and 7.5 ± 2.5 vs. 3.2 ± 0.5 m/s, respectively, P < 0.01). Wire myography revealed (range of 23%-31%) impaired aortic relaxation in all ecig exposure groups (with or without nicotine). Incubation of vessels with TEMPOL or Febuxostat reversed the aortic dysfunction, implicating the involvement of reactive oxygen species. Nearly identical changes and pattern was seen in vascular outcomes of 7-mo-old offspring. The take-home message from this preclinical study is that maternal vaping during pregnancy, with or without nicotine, leads to maladaptations in vascular (aortic) development that persist into adult life of offspring.NEW & NOTEWORTHY We observe a significant alteration in arterial structure and function in adolescent and adult offspring due to developmental exposure to toxicants resulting from perinatal maternal vaping. Taken together with previous work that described lasting dysfunction in cerebral microvasculature in offspring, these data underscore the adverse consequences of maternal exposure to electronic cigarette aerosol in conduit and resistance vessels alike, irrespective of nicotine content.
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Affiliation(s)
- Eiman Aboaziza
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kimberly Feaster
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lance Hare
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Paul D Chantler
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - I Mark Olfert
- West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
- WVU Center of Inhalation Toxicology, West Virginia University School of Medicine, Morgantown, West Virginia
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia
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Conklin DJ. How Irritating! Electronic Cigarettes Not "95% Safer" Than Combustible Cigarettes: Recent Mechanistic Insights Into Endothelial Dysfunction. Arterioscler Thromb Vasc Biol 2022; 42:1351-1354. [PMID: 36288291 PMCID: PMC10038145 DOI: 10.1161/atvbaha.122.318468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Daniel J. Conklin
- American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville
- Christina Lee Brown Envirome Institute, University of Louisville
- Superfund Research Center, University of Louisville
- Center of Cardiovascular Metabolism Science, University of Louisville
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, KY 40202, USA
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