Cardiovascular System


A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects

Andrea R. Vansickel, Caroline O. Cobb, Michael F Weaver, Thomas E. Eissenberg
Published online: 20 Jul 2010

Heart rate increased from an average (SD) of 65.7 (10.4) bpm at baseline to a peak of 80.3 (10.9) bpm five minutes after the first administration under the tobacco cigarette condition. No significant changes in heart rate were observed for the e-cigarette or sham conditions.

Under these acute testing conditions, neither of the electronic cigarettes exposed users to measurable levels of nicotine or CO, although both suppressed nicotine/tobacco abstinence symptom ratings. 


Acute effects of electronic and tobacco cigarette smoking on complete blood count

Andreas D. Flouris, Konstantina P. Poulianiti Maria S. Chorti, Athanasios Z. Jamurtas, Dimitrios Kouretas, Emmanuel O. Owolabi, Manolis N. Tzatzarakis, Aristidis M. Tsatsakis, Yiannis Koutedakis
Published online: Oct 2012

Active and passive tobacco cigarette smoking increased white blood cell, lymphocyte, and granulocyte counts for at least one hour in smokers and never smokers. Active and passive tobacco cigarette smoking increase the secondary proteins of acute inflammatory load for at least one hour.

It is concluded that acute active and passive smoking using the e-cigarettes tested in the current study does not influence CBC indices in smokers and never smokers. The results demonstrated that CBC indices remained unchanged during the control session and the active and passive e-cigarette smoking sessions.


Chronic Idiopathic Neutrophilia in A Smoker, Relieved after Smoking Cessation with the Use of Electronic Cigarette: a Case Report

Konstantinos E. Farsalinos, Giorgio Romagna
Published online: 23 Jan 2013

A male Caucasian patient, born in 1977, presented in September 2005 with asymptomatic elevation of white blood cell and neutrophil count, and mildly-elevated C-reactive protein levels. He was a smoker since 1996 and was treated with 20 mg/day of simvastatin since 2003 due to hyperlipidemia. Clinical examination, and laboratory and imaging investigations ruled out any infectious, haematological, rheumatological, or endocrine conditions. He was followed-up regularly and was advised to stop smoking. He had 2 unsuccessful attempts to quit smoking; one was unassisted and the second was performed with the use of both varenicline and nicotine replacement therapy (patches). During the subsequent 6.5 years, his leukocyte and C-reactive protein levels were repeatedly elevated; the condition was consistent with chronic idiopathic neutrophilia. In February 2012, he started using electronic cigarettes and he managed to quit smoking within 10 days. After 6 months, laboratory examination showed normalized leukocyte count and C-reactive protein levels, confirmed immediately by a second laboratory and by repeated tests after 1 and 2 months.

Smoking cessation with the use of electronic cigarette led to reversal of chronic idiopathic neutrophilia. The daily use of electronic cigarette may help preserve the beneficial effects of smoking cessation.


Cigarette smoke but not electronic cigarette aerosol activates a stress response in human coronary artery endothelial cells in culture

Jack E. Teasdale, Andrew C. Newby, Nicholas J. Timpson, Marcus R. Munafòb, Stephen, J. White
Published online: 1 Jun 2016

Human coronary artery endothelial cells show a biological response to cigarette smoke.

This response was not seen following exposure to e-cigarette aerosol.

Using e-cigarettes instead of cigarettes may reduce immediate cardiovascular harms.


Have combustible cigarettes met their match? The nicotine delivery profiles and harmful constituent exposures of second-generation and third-generation electronic cigarette users

Theodore L Wagener, Evan L Floyd, Irina Stepanov, Leslie M Driskill, Summer G Frank, Ellen Meier, Eleanor L Leavens, Alayna P Tackett, Neil Molina, Lurdes Queimado
Published online: 21 Mar 2017

While not harmless, electronic cigarettes (e-cigarettes) have demonstrated a much more favourable toxicological profile than combustible cigarettes—the worldwide leading cause of preventable death. Average eCO levels (ppm) were significantly higher in smokers than in e-cigarette users. Compared with cigarettes, G2 and G3 e-cigarettes resulted in significantly lower levels of exposure to a potent lung carcinogen and cardiovascular toxicant.

Electronic cigarette smoking increases of arterial stifness and oxidative stress to a lesser extent than a single normal cigarette: an acute and chronic study

I. Ikonomidis, D. Vlastos, G. Kostelli, K. Kourea, O. Kondylopoulou, S. Vlachos, D. Benas, M. Varoudi, G. Pavlidis, V. Dede, H. Triantafyllidi, I. Andreadou, J. Lekakis
Published online: 29 Aug 2017

Electronic cigarette smoking causes a smaller increase of arterial stiffness and oxidative stress, compared to a single normal cigarette in an acute setting. Replacement of normal cigarettes by a moderate nicotine concentration electronic cigarette results in improved aortic elasticity and oxidative stress within 1 month.


Is e-cigarette use associated with coronary heart disease and myocardial infarction? Insights from the 2016 and 2017 National Health Interview Surveys

Konstantinos E Farsalinos, Riccardo Polosa, Fabio Cibella, Raymond Niaura
Published online: 27 Sep 2019

The pooled analysis of the 2016 and 2017 NHIS showed no association between e-cigarette use and MI or CHD. The associations between established risk factors, including smoking, and both conditions were remarkably consistent. The inconsistent associations observed in single-year surveys and the cross-sectional design of the NHIS cannot substantiate any link between e-cigarette use and an elevated risk for MI or CHD. Longitudinal studies are needed to explore the effects of e-cigarette use on cardiovascular disease.

Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes

Jacob George MD, Muhammad Hussain MSc, Thenmalar Vadiveloo PhD, Sheila Ireland BSc, Pippa Hopkinson BSc, Allan D. Struthers MD, Peter T. Donnan PhD, Faisel Khan PhD, Chim C. Lang MD
Published online: 15 Nov 2019

E-cigarette (EC) use is increasing exponentially worldwide. The early cardiovascular effects of switching from tobacco cigarettes (TC) to EC in chronic smokers is unknown. Meta-analysis of flow-mediated dilation (FMD) studies indicate 13% lower pooled, adjusted relative risks of cardiovascular events with every 1% improvement in FMD.

Electronic cigarettes and cardiovascular health: what do we know so far?

MacDonald A, Middlekauff HR
Published online: 29 Apr 2019

Though they may not be as harmless as previously proposed, it seems likely that on the spectrum of tobacco products, ECs are less harmful than TCs, and there is increasing evidence that ECs may help promote TC cessation. As such, ECs may be helpful for risk reduction


Effects of electronic cigarette on platelet and vascular function after four months of use

Ignatios Ikonomidis, Konstantinos Katogiannis, Gavriella Kostelli, Kallirhoe Kourea, Elias Kyriakou, Athina Kypraiou, Maria Tsoumani, Ioanna Andreadou, Vaia Lambadiari, Panagiotis Plotas, Ioannis Thymis, Argirios E. Tsantes
Published online: Jul 2020

Electronic Cigarette vaping for four months, has a neutral effect on platelet aggregation of healthy smokers.

Continuation of tobacco cigarette smoking further deteriorates platelet function during 4 months of use.

Electronic cigarette vaping improves arterial elastic properties and oxidative stress after 4 months of use

Tobacco cigarette smoking causes further impairment of arterial elasticity and oxidative stress during 4 months of use

Differential effects of tobacco cigarettes and electronic cigarettes on endothelial function in healthy young people

Kacey P. Haptonstall, Yasmine Choroomi, Roya Moheimani, Kevin Nguyen, Elizabeth Tran, Karishma Lakhani, Isabella Ruedisueli, Jeffrey Gornbein, Holly R. Middlekauff

Endothelial dysfunction, as measured by flow mediated vasodilation(FMD) is a predictor of future atherosclerosis and adverse cardiovascular events, and is impaired in tobacco cigarette (TC) smokers.

FMD was significantly impaired after smoking one TC, but not after vaping an equivalent “dose”(estimated plasma nicotine) of an e-cigarette (EC), consistent with the notion that non-nicotine constituents in TC smoke mediate the impairment.


E-Cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study (2013–2019)

Jonathan B. Berlowitz, Wubin Xie, Alyssa F. Harlow, Naomi M. Hamburg, Michael J. Blaha, Aruni Bhatnagar, Emelia J. Benjamin and Andrew C. Stokes

Adults who exclusively use electronic cigarettes experience a 34% reduction in their risk of heart disease.

“The study used a longitudinal design, following approximately 32,000 adults over a six-year period from 2013 to 2019. E-cigarette use and tobacco cigarette use were assessed periodically, as was self-reported heart disease, including a heart attack, heart failure, or stroke. The study examined the risk of incident heart disease for smokers compared to exclusive e-cigarette users, dual users, and nonsmokers, while controlling for age, sex, race/ethnicity, education, body mass index, hypertension, high cholesterol, diabetes, and family history of heart disease.

Compared to nonsmokers, smokers experienced a risk of heart disease that was 1.8 times higher and this difference was statistically significant. Compared to nonsmokers, exclusive e-cigarette users experienced a risk of heart disease that was not statistically different. Thus, the study confirmed a strong link between smoking and heart disease, but did not find any evidence of a link between vaping and heart disease.

Compared to smokers, exclusive e-cigarette users experienced a risk of heart disease that was 34% lower and this difference was statistically significant.

Importantly, the health benefits of switching to vaping were only present for exclusive e-cigarette users. Dual users of both e-cigarettes and cigarettes did not experience any decline in their risk of heart disease.”

Dr. Michael Siegel: