Cardiovascular and Pulmonary Responses to Acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-Term Users.
Level 3 - non-randomized controlled study
Non-randomized controlled comparative challenge study
PubMed 37044158 · doi:10.1016/j.chest.2023.03.047
What was done
An observational challenge study assessed cardiovascular and pulmonary responses before and after a 15-minute nicotine product use challenge in 395 adults: exclusive fourth-generation electronic nicotine delivery system (ENDS) users (n = 164; exhaled CO < 5 ppm, 82% urine cotinine-positive), exclusive cigarette smokers (n = 117; CO > 5 ppm, urine cotinine-positive), and non-tobacco controls (n = 114; CO < 5 ppm, urine cotinine-negative).
What was found
During the 15-minute challenge, cigarette smokers took a median of 14.0 puffs (IQR, 9.3) versus 9.0 puffs (IQR, 7.5) in ENDS users (P < .001). Compared with non-using controls, ENDS users experienced significantly greater adjusted mean increases in systolic blood pressure (5.6 mm Hg [95% CI, 4.4-6.8] vs 2.3 mm Hg [95% CI, 0.8-3.8]; P = .001), diastolic blood pressure (4.2 mm Hg [95% CI, 3.3-5.0] vs 2.0 mm Hg [95% CI, 1.1-3.0]; P = .003), and heart rate (4.8 beats/min [95% CI, 4.0-5.6] vs -1.3 beats/min [95% CI, -2.2 to -0.3]; P < .001). ENDS users also showed greater decreases in brachial artery diameter (-0.011 cm vs -0.006 cm; P = .003), time-domain heart rate variability (-7.2 ms vs +3.6 ms; P = .001), and FEV1 (-4.1 vs -1.1; P = .005), matching changes observed in cigarette smokers. On treadmill testing, ENDS users showed worse exercise performance than controls, notably metabolic equivalents (adjusted mean difference, 1.28 METs; P < .001) and delayed 60-second heart rate recovery (adjusted mean difference, 2.9 beats/min; P = .008).
Why it matters
Acute e-cigarette use produces rapid autonomic imbalance, endothelial vasoconstriction, airway obstruction, and exercise impairment that closely mirror the acute cardiorespiratory insults of smoking combustible cigarettes.
Limits
The non-randomized observational design cannot fully exclude baseline confounding among user groups. Only acute, immediate physiological responses following a single 15-minute challenge were assessed, which may not directly capture long-term clinical cardiovascular outcomes. Product administration was ad libitum, resulting in differing puff counts across product groups.
Cited by
- supports Nicotine raises blood pressure and acts as a vasoconstrictor.