Cardiovascular Effects of Switching from Tobacco Cigarettes to Electronic Cigarettes

Jacob George (Lead / Corresponding author), Muhammad Hussain, Thenmalar Vadiveloo, Sheila Ireland, Pippa Hopkinson, Allan D. Struthers, Peter T. Donnan, Faisel Khan, Chim C. Lang

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: 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.

OBJECTIVES: This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers.

METHODS: The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers ≥18 years of age who had smoked ≥15 cigarettes/day for ≥2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels.

RESULTS: Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend β = 0.73%; 95% confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49%; 95% CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (-0.529 m/s; 95% CI: -0.946 to -0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study time frame.

CONCLUSIONS: TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use [VESUVIUS]; NCT02878421; ISRCTN59133298).

Original languageEnglish
Number of pages9
JournalJournal of the American College of Cardiology
Early online date15 Nov 2019
DOIs
Publication statusE-pub ahead of print - 15 Nov 2019

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Tobacco Products
Tobacco
Blood Vessels
Nicotine
Dilatation
Confidence Intervals
Electronic Cigarettes
Harm Reduction
Propensity Score
Pulse Wave Analysis
Vascular Stiffness
Carbon Monoxide
Meta-Analysis
Cardiovascular Diseases

Keywords

  • Endothelial function
  • electronic cigarette
  • vascular stiffness

Cite this

@article{7d559f61c69647f58d2e83ba82930040,
title = "Cardiovascular Effects of Switching from Tobacco Cigarettes to Electronic Cigarettes",
abstract = "BACKGROUND: 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.OBJECTIVES: This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers.METHODS: The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers ≥18 years of age who had smoked ≥15 cigarettes/day for ≥2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels.RESULTS: Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend β = 0.73{\%}; 95{\%} confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49{\%}; 95{\%} CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (-0.529 m/s; 95{\%} CI: -0.946 to -0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study time frame.CONCLUSIONS: TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use [VESUVIUS]; NCT02878421; ISRCTN59133298).",
keywords = "Endothelial function, electronic cigarette, vascular stiffness",
author = "Jacob George and Muhammad Hussain and Thenmalar Vadiveloo and Sheila Ireland and Pippa Hopkinson and Struthers, {Allan D.} and Donnan, {Peter T.} and Faisel Khan and Lang, {Chim C.}",
note = "Funding: British Heart Foundation (PG/15/64/31681)",
year = "2019",
month = "11",
day = "15",
doi = "10.1016/j.jacc.2019.09.067",
language = "English",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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}

Cardiovascular Effects of Switching from Tobacco Cigarettes to Electronic Cigarettes. / George, Jacob (Lead / Corresponding author); Hussain, Muhammad; Vadiveloo, Thenmalar; Ireland, Sheila; Hopkinson, Pippa; Struthers, Allan D.; Donnan, Peter T.; Khan, Faisel; Lang, Chim C.

In: Journal of the American College of Cardiology, 15.11.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiovascular Effects of Switching from Tobacco Cigarettes to Electronic Cigarettes

AU - George, Jacob

AU - Hussain, Muhammad

AU - Vadiveloo, Thenmalar

AU - Ireland, Sheila

AU - Hopkinson, Pippa

AU - Struthers, Allan D.

AU - Donnan, Peter T.

AU - Khan, Faisel

AU - Lang, Chim C.

N1 - Funding: British Heart Foundation (PG/15/64/31681)

PY - 2019/11/15

Y1 - 2019/11/15

N2 - BACKGROUND: 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.OBJECTIVES: This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers.METHODS: The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers ≥18 years of age who had smoked ≥15 cigarettes/day for ≥2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels.RESULTS: Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend β = 0.73%; 95% confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49%; 95% CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (-0.529 m/s; 95% CI: -0.946 to -0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study time frame.CONCLUSIONS: TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use [VESUVIUS]; NCT02878421; ISRCTN59133298).

AB - BACKGROUND: 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.OBJECTIVES: This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers.METHODS: The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers ≥18 years of age who had smoked ≥15 cigarettes/day for ≥2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels.RESULTS: Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend β = 0.73%; 95% confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49%; 95% CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (-0.529 m/s; 95% CI: -0.946 to -0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study time frame.CONCLUSIONS: TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use [VESUVIUS]; NCT02878421; ISRCTN59133298).

KW - Endothelial function

KW - electronic cigarette

KW - vascular stiffness

U2 - 10.1016/j.jacc.2019.09.067

DO - 10.1016/j.jacc.2019.09.067

M3 - Article

C2 - 31740017

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

ER -