E-cigs could be more harmful to CV health than traditional cigarettes

A study out of the Smidt Heart Institute at Cedars-Sinai Medical Center suggests e-cigarettes—the culprit behind a vaping epidemic that’s injured more than 2,000 and claimed the lives of at least 39—could be more harmful to CV health than traditional cigarettes.

Florian Rader, MD, MSc, medical director of the Human Physiology Laboratory at the Smidt Heart Institute, and his colleagues are set to present their findings at the American Heart Association’s annual Scientific Sessions, which kick off Nov. 16 in Philadelphia. The team studied young-adult smokers, comparing blood flow and vascular function between people who regularly used e-cigs and those who regularly smoked tobacco cigarettes.

Rader et al. measured blood flow to the heart before and after smoking episodes, both while participants were at rest and after they performed a handgrip exercise to simulate physiological stress. Adults who smoked traditional cigarettes saw a modest increase in blood flow after inhalation that decreased with subsequent stress; e-cigarette users saw a decrease in blood flow at rest and after the handgrip exercise.

“Our results suggest that e-cigarette use is associated with coronary vascular dysfunction at rest, even in the absence of physiologic stress,” Susan Cheng, MD, MPH, director of Public Health Research at the Smidt Heart Institute, said in a release. “These findings indicate the opposite of what e-cigarette and vaping marketing is saying about their safety profile.”

Despite strenuous attempts by local and federal bodies to limit the distribution of potentially harmful vaping products, the use of e-cigs has soared in recent years. A poll from the FDA found that 27.5% of high school students admitted to smoking e-cigarettes in 2019—nearly 7 percentage points higher than the same statistic in 2018.

“What makes e-cigarettes so harmful to the heart and lungs is not just nicotine,” Rader said in the release. “It’s the completely unknown bucket of manufactured products used to form vapors that is likely causing the most harm. This is what we believe is underlying the current public health problem.”

This month the CDC confirmed that the cause of most recent injuries and deaths from EVALI (e-cigarette or vaping product use-associated lung injury) is Vitamin E acetate, a chemical that’s used in various supplements and skin creams. While it’s been deemed safe as a topical or oral agent, the chemical seems to cause harm when inhaled.

Rader, Cheng and the rest of their research team are continuing to conduct research on the mechanisms underlying vascular changes brought on by EVALI. They’re also working to expand their research pool to a more diverse population, including those with pre-existing CV risk.

 “What we are learning from our own research, along with the work of others, is that use of any electronic nicotine delivery system should be considered with a high degree of caution until more data can be gathered,” Rader said.