Effects of e-cigarettes and vaping devices on cardiac and pulmonary physiology

MuChun Tsai, Min Kwang Byun, John Shin, Laura E Crotty Alexander, MuChun Tsai, Min Kwang Byun, John Shin, Laura E Crotty Alexander

Abstract

E-cigarette aerosols are exceedingly different from conventional tobacco smoke, containing dozens of chemicals not found in cigarette smoke. It is highly likely that chronic use of e-cigarettes will induce pathological changes in both the heart and lungs. Here we review human and animal studies published to date and summarize the cardiopulmonary physiological changes caused by vaping. In terms of cardiac physiology, acute exposure to e-cigarette aerosols in human subjects led to increased blood pressure and heart rate, similar to traditional cigarettes. Chronic exposure to e-cigarette aerosols using animal models caused increased arterial stiffness, vascular endothelial changes, increased angiogenesis, cardiorenal fibrosis and increased atherosclerotic plaque formation. Pulmonary physiology is also affected by e-cigarette aerosol inhalation, with increased airway reactivity, airway obstruction, inflammation and emphysema. Research thus far demonstrates that the heart and lung undergo numerous changes in response to e-cigarette use, and disease development will depend on how those changes combine with both environmental and genetic factors. E-cigarettes have been advertised as a healthy alternative to cigarette smoking, and users are under the impression that vaping of e-cigarettes is harmless, but these claims that e-cigarettes are safer and healthier are not based on evidence. Data from both humans and animal models are consistent in demonstrating that vaping of e-cigarettes causes health effects both similar to and disparate from those of cigarette smoking. Further work is needed to define the long-term cardiopulmonary effects of e-cigarette use in humans.

Keywords: animal models; cardiac function; cardiopulmonary physiology; clinical research; e-cigarette; inflammation; lung function; nicotine; vaping.

Conflict of interest statement

Competing interests

The authors declare that they have no competing interests.

© 2020 The Authors. The Journal of Physiology © 2020 The Physiological Society.

Figures

Figure 1.
Figure 1.
E-cigarette research conducted to date, utilizing both humans and animal models, has defined a multitude of changes in cardiopulmonary physiology induced by the inhalation of e-cigarette aerosols

References

    1. Alasmari F, Crotty Alexander LE, Nelson JA, Schiefer IT, Breen E, Drummond CA & Sari Y (2017). Effects of chronic inhalation of electronic cigarettes containing nicotine on glial glutamate transporters and alpha-7 nicotinic acetylcholine receptor in female CD-1 mice. Prog Neuropsychopharmacol Biol Psychiatry 77, 1–8.
    1. Antoniewicz L, Bosson JA, Kuhl J, Abdel-Halim SM, Kiessling A, Mobarrez F & Lundback M (2016). Electronic cigarettes increase endothelial progenitor cells in the blood of healthy volunteers. Atherosclerosis 255, 179–185.
    1. Antoniewicz L, Brynedal A, Hedman L, Lundback M & Bosson JA (2019). Acute effects of electronic cigarette inhalation on the vasculature and the conducting airways. Cardiovasc Toxicol 19, 441–450.
    1. Bero LA, Glantz S & Hong MK (2005). The limits of competing interest disclosures. Tob Control 14, 118–126.
    1. Bhat TA, Kalathil SG, Bogner PN, Blount BC, Goniewicz ML & Thanavala YM (2020). An animal model of inhaled vitamin E acetate and EVALI-like lung injury. N Engl J Med 382, 1175–1177.
    1. Blount BC, Karwowski MP, Shields PG, Morel-Espinosa M, Valentin-Blasini L, Gardner M, Braselton M, Brosius CR, Caron KT, Chambers D, Corstvet J, Cowan E, De Jesus VR, Espinosa P, Fernandez C, Holder C, Kuklenyik Z, Kusovschi JD, Newman C, Reis GB, Rees J, Reese C, Silva L, Seyler T, Song MA, Sosnoff C, Spitzer CR, Tevis D, Wang L, Watson C, Wewers MD, Xia B, Heitkemper DT, Ghinai I, Layden J, Briss P, King BA, Delaney LJ, Jones CM, Baldwin GT, Patel A, Meaney-Delman D, Rose D, Krishnasamy V, Barr JR, Thomas J & Pirkle JL & Lung Injury Response Laboratory Working Group (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med 382, 697–705.
    1. Boddu SA, Bojanowski CM, Lam MT, Advani IN, Scholten EL,Sun X, Montgrain P, Malhotra A, Jain S & Crotty Alexander LE (2019). Use of E-cigarettes with conventional tobacco is associated with decreased sleep quality in women. Am J Respir Crit Care Med 200, 1431–1434.
    1. Bousquet J, Bachert C, Alexander LC & Leone FT (2016). Hypothesis: may e-cigarette smoking boost the allergic epidemic? Clin Transl Allergy 6, 40.
    1. Bowler RP, Hansel NN, Jacobson S, Graham Barr R, Make BJ, Han MK, O’Neal WK, Oelsner EC, Casaburi R, Barjaktarevic I, Cooper C, Foreman M, Wise RA, DeMeo DL, Silverman EK, Bailey W, Harrington KF & Woodruff PG & Drummond MB (for COPDGene and SPIROMICS Investigators) (2017). Electronic cigarette use in US adults at risk for or with COPD: analysis from two observational cohorts. J Gen Intern Med 32, 1315–1322.
    1. Capps B (2016). Can a good tree bring forth evil fruit? The funding of medical research by industry. Br Med Bull 118, 5–15.
    1. Chaumont M, de Becker B, Zaher W, Culie A, Deprez G, Melot C, Reye F, Van Antwerpen P, Delporte C, Debbas N, Boudjeltia KZ & van de Borne P (2018). Differential effects of e-cigarette on microvascular endothelial function, arterial stiffness and oxidative stress: a randomized crossover trial. Sci Rep 8, 10378.
    1. Cibella F, Campagna D, Caponnetto P, Amaradio MD, Caruso M, Russo C, Cockcroft DW & Polosa R (2016). Lung function and respiratory symptoms in a randomized smoking cessation trial of electronic cigarettes. Clin Sci 130, 1929–1937.
    1. Corriden R, Moshensky A, Bojanowski CM, Meier A, Chien J, Nelson RK & Crotty Alexander LE (2020). E-cigarette use increases susceptibility to bacterial infection by impairment of human neutrophil chemotaxis, phagocytosis, and NET formation. Am J Physiol Cell Physiol 318, C205–C214.
    1. Crotty Alexander LE, Drummond CA, Hepokoski M, Mathew D, Moshensky A, Willeford A, Das S, Singh P, Yong Z, Lee JH, Vega K, Du A, Shin J, Javier C, Tian J, Brown JH & Breen EC (2018). Chronic inhalation of e-cigarette vapor containing nicotine disrupts airway barrier function and induces systemic inflammation and multiorgan fibrosis in mice. Am J Physiol Regul Integr Comp Physiol 314, R834–R847.
    1. Crotty Alexander LE, Shin S & Hwang JH (2015a). Inflammatory diseases of the lung induced by conventional cigarette smoke: a review. Chest 148, 1307–1322.
    1. Crotty Alexander LE, Shin S & Hwang JH (2015b). Inflammatory diseases of the lung induced by conventional cigarette smoke: a review. Chest 148, 1307–1322.
    1. Crotty Alexander LE, Ware LB, Calfee CS, Callahan SJ, Eissenberg T, Farver C, Goniewicz ML, Jaspers I, Kheradmand F, King TE Jr, Meyer NJ, Mikheev V, Shields PG, Shihadeh A, Strongin R & Tarran R (2020). NIH workshop report: e-cigarette or vaping product use associated lung injury (EVALI): developing a research agenda. Am J Respir Crit Care Med 202, 795–802.
    1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems (2018). Public Health Consequences of E-Cigarettes, eds Eaton DL, Kwan LY & Stratton K National Academies Press (US), Washington, DC.
    1. Espinoza-Derout J, Hasan KM, Shao XM, Jordan MC, Sims C, Lee DL, Sinha S, Simmons Z, Mtume N, Liu Y, Roos KP, Sinha-Hikim AP & Friedman TC (2019). Chronic intermittent electronic cigarette exposure induces cardiac dysfunction and atherosclerosis in apolipoprotein-E knockout mice. Am J Physiol Heart Circ Physiol 317, H445–H459.
    1. Ferrari M, Zanasi A, Nardi E, Morselli Labate AM, Ceriana P, Balestrino A, Pisani L, Corcione N & Nava S (2015). Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers. BMC Pulm Med 15, 120.
    1. Fetterman JL, Keith RJ, Palmisano JN, McGlasson KL, Weisbrod RM, Majid S, Bastin R, Stathos MM, Stokes AC, Robertson RM, Bhatnagar A & Hamburg NM (2020). Alterations in vascular function associated with the use of combustible and electronic cigarettes. J Am Heart Assoc 9, e014570.
    1. Flouris AD, Chorti MS, Poulianiti KP, Jamurtas AZ, Kostikas K, Tzatzarakis MN, Wallace Hayes A, Tsatsakis AM & Koutedakis Y (2013). Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol 25, 91–101.
    1. Fogt DL, Levi MA, Rickards CA, Stelly SP & Cooke WH (2016). Effects of acute vaporized nicotine in non-tobacco users at rest and during exercise. Int J Exerc Sci 9, 607–615.
    1. Franzen KF, Willig J, Cayo Talavera S, Meusel M, Sayk F, Reppel M, Dalhoff K, Mortensen K & Droemann D (2018). E-cigarettes and cigarettes worsen peripheral and central hemodynamics as well as arterial stiffness: A randomized, double-blinded pilot study. Vasc Med 23, 419–425.
    1. Garcia-Arcos I, Geraghty P, Baumlin N, Campos M, Dabo AJ, Jundi B, Cummins N, Eden E, Grosche A, Salathe M & Foronjy R (2016). Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner. Thorax 71, 1119–1129.
    1. Garcia-Gomez D, Gaisl T, Barrios-Collado C, Vidal-de-Miguel G, Kohler M & Zenobi R (2016). Real-time chemical analysis of e-cigarette aerosols by means of secondary electrospray ionization mass spectrometry. Chemistry 22, 2452–2457.
    1. George J, Hussain M, Vadiveloo T, Ireland S, Hopkinson P, Struthers AD, Donnan PT, Khan F & Lang CC (2019). Cardiovascular effects of switching from tobacco cigarettes to electronic cigarettes. J Am Coll Cardiol 74, 3112–3120.
    1. Ghosh A, Coakley RD, Ghio AJ, Muhlebach MS, Esther CR Jr, Alexis NE & Tarran R (2019). Chronic e-cigarette use increases neutrophil elastase and matrix metalloprotease levels in the lung. Am J Respir Crit Care Med 200, 1392–1401.
    1. Glynos C, Bibli SI, Katsaounou P, Pavlidou A, Magkou C, Karavana V, Topouzis S, Kalomenidis I, Zakynthinos S & Papapetropoulos A (2018). Comparison of the effects of e-cigarette vapor with cigarette smoke on lung function and inflammation in mice. Am J Physiol Lung Cell Mol Physiol 315, L662–L672.
    1. Harvanko AM, Havel CM, Jacob P & Benowitz NL (2020). Characterization of nicotine salts in 23 electronic cigarette refill liquids. Nicotine Tob Res 22, 1239–1243.
    1. Hawk ET & Colbert Maresso K (2019). E-cigarettes: unstandardized, under-regulated, understudied, and unknown health and cancer risks. Cancer Res 79, 6079–6083.
    1. Hwang JH, Lyes M, Sladewski K, Enany S, McEachern E, Mathew DP, Das S, Moshensky A, Bapat S, Pride DT, Ongkeko WM & Crotty Alexander LE (2016). Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria. J Mol Med 94, 667–679.
    1. Ikonomidis I, Katogiannis K, Kostelli G, Kourea K, Kyriakou E, Kypraiou A, Tsoumani M, Andreadou I, Lambadiari V, Plotas P, Thymis I & Tsantes AE (2020). Effects of electronic cigarette on platelet and vascular function after four months of use. Food Chem Toxicol 141, 111389.
    1. Kaisar MA, Prasad S, Liles T & Cucullo L (2016). A decade of e-cigarettes: limited research & unresolved safety concerns. Toxicology 365, 67–75.
    1. Kerr DMI, Brooksbank KJM, Taylor RG, Pinel K, Rios FJ, Touyz RM & Delles C (2019). Acute effects of electronic and tobacco cigarettes on vascular and respiratory function in healthy volunteers: a cross-over study. J Hypertens 37, 154–166.
    1. Khan NA, Yogeswaran S, Wang Q, Muthumalage T, Sundar IK & Rahman I (2019). Waterpipe smoke and e-cigarette vapor differentially affect circadian molecular clock gene expression in mouse lungs. PLoS One 14, e0211645.
    1. Kosmider L, Kimber CF, Kurek J, Corcoran O & Dawkins LE (2018). Compensatory puffing with lower nicotine concentration e-liquids increases carbonyl exposure in e-cigarette aerosols. Nicotine Tob Res 20, 998–1003.
    1. Kosmider L, Sobczak A, Prokopowicz A, Kurek J, Zaciera M, Knysak J, Smith D & Goniewicz ML (2016). Cherry-flavoured electronic cigarettes expose users to the inhalation irritant, benzaldehyde. Thorax 71, 376–377.
    1. Lappas AS, Tzortzi AS, Konstantinidi EM, Teloniatis SI, Tzavara CK, Gennimata SA, Koulouris NG & Behrakis PK (2018). Short-term respiratory effects of e-cigarettes in healthy individuals and smokers with asthma. Respirology 23, 291–297.
    1. Lechner WV, Tackett AP, Grant DM, Tahirkheli NN, Driskill LM & Wagener TL (2015). Effects of duration of electronic cigarette use. Nicotine Tob Res 17, 180–185.
    1. Lee J & Cooke JP (2011). The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis 215, 281–283.
    1. Madison MC, Landers CT, Gu BH, Chang CY, Tung HY, You R, Hong MJ, Baghaei N, Song LZ, Porter P, Putluri N, Salas R, Gilbert BE, Levental I, Campen MJ, Corry DB & Kheradmand F (2019). Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine. J Clin Invest 129, 4290–4304.
    1. Mayyas F, Aldawod H, Alzoubi KH, Khabour O, Shihadeh A & Eissenberg T (2020). Comparison of the cardiac effects of electronic cigarette aerosol exposure with waterpipe and combustible cigarette smoke exposure in rats. Life Sci 251, 117644.
    1. McGrath-Morrow SA, Hayashi M, Aherrera A, Lopez A, Malinina A, Collaco JM, Neptune E, Klein JD, Winickoff JP, Breysse P, Lazarus P & Chen G (2015). The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. PLoS One 10, e0118344.
    1. Middlekauff HR, Park J & Moheimani RS (2014). Adverse effects of cigarette and noncigarette smoke exposure on the autonomic nervous system: mechanisms and implications for cardiovascular risk. J Am Coll Cardiol 64, 1740–1750.
    1. Miech R, Johnston L, O’Malley PM, Bachman JG & Patrick ME (2019). Trends in adolescent vaping, 2017–2019. N Engl J Med 381, 1490–1491.
    1. Mobarrez F, Antoniewicz L, Hedman L, Bosson JA & Lundback M (2020). Electronic cigarettes containing nicotine increase endothelial and platelet derived extracellular vesicles in healthy volunteers. Atherosclerosis 301, 93–100.
    1. Moheimani RS, Bhetraratana M, Peters KM, Yang BK, Yin F, Gornbein J, Araujo JA & Middlekauff HR (2017). Sympathomimetic effects of acute e-cigarette use: role of nicotine and non-nicotine constituents. J Am Heart Assoc 6, e006579.
    1. Nabavizadeh P, Liu J, Havel CM, Ibrahim S, Derakhshandeh R, Jacob Iii P & Springer ML (2018). Vascular endothelial function is impaired by aerosol from a single IQOS HeatStick to the same extent as by cigarette smoke. Tob Control 27, s13–s19.
    1. Neunteufl T, Heher S, Kostner K, Mitulovic G, Lehr S, Khoschsorur G, Schmid RW, Maurer G & Stefenelli T (2002). Contribution of nicotine to acute endothelial dysfunction in long-term smokers. J Am Coll Cardiol 39, 251–256.
    1. Olfert IM, DeVallance E, Hoskinson H, Branyan KW, Clayton S, Pitzer CR, Sullivan DP, Breit MJ, Wu Z, Klinkhachorn P, Mandler WK, Erdreich BH, Ducatman BS, Bryner RW, Dasgupta P & Chantler PD (2018). Chronic exposure to electronic cigarettes results in impaired cardiovascular function in mice. J Appl Physiol 124, 573–582.
    1. Perez M & Crotty Alexander LE (2020). Why is vaping going up in flames? Ann Am Thorac Soc 17, 545–549.
    1. Pisinger C, Godtfredsen N & Bender AM (2019). A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes. Prev Med 119, 124–131.
    1. Quanjer PH, Weiner DJ, Pretto JJ, Brazzale DJ & Boros PW (2014). Measurement of FEF25–75% and FEF75% does not contribute to clinical decision making. Eur Respir J 43, 1051–1058.
    1. Rao P, Liu J & Springer ML (2020). JUUL and combusted cigarettes comparably impair endothelial function. Tob Regul Sci 6, 30–37.
    1. Reid KM, Forrest JR & Porter L(2018). Tobacco Product Use Among Youths With and Without Lifetime Asthma—Florida, 2016. MMWR Morb Mortal Wkly Rep 67, 599–601.
    1. Shi H, Fan X, Horton A, Haller ST, Kennedy DJ, Schiefer IT, Dworkin L, Cooper CJ & Tian J (2019). The effect of electronic-cigarette vaping on cardiac function and angiogenesis in mice. Sci Rep 9, 4085.
    1. Shin S & Crotty Alexander LE (2016). Global state of tobacco use: summary from the American Thoracic Society International Conference 2016. J Thorac Dis 8, S582–S585.
    1. St Helen G, Liakoni E, Nardone N, Addo N, Jacob P 3rd & Benowitz NL (2020). Comparison of systemic exposure to toxic and/or carcinogenic volatile organic compounds (VOC) during vaping, smoking, and abstention. Cancer Prev Res 13, 153–162.
    1. Staudt MR, Salit J, Kaner RJ, Hollmann C & Crystal RG (2018). Altered lung biology of healthy never smokers following acute inhalation of E-cigarettes. Respir Res 19, 78.
    1. Stegh AH (2012). Targeting the p53 signaling pathway in cancer therapy - the promises, challenges and perils. Expert Opin Ther Targets 16, 67–83.
    1. Tierney PA, Karpinski CD, Brown JE, Luo W & Pankow JF (2016). Flavour chemicals in electronic cigarette fluids. Tob Control 25, e10–e15.
    1. Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN & Behrakis PK (2012). Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest 141, 1400–1406.
    1. Velicer C, St Helen G & Glantz SA (2018). Tobacco papers and tobacco industry ties in regulatory toxicology and pharmacology. J Public Health Policy 39, 34–48.
    1. Vlachopoulos C, Ioakeimidis N, Abdelrasoul M, Terentes-Printzios D, Georgakopoulos C, Pietri P, Stefanadis C & Tousoulis D (2016). Electronic cigarette smoking increases aortic stiffness and blood pressure in young smokers. J Am Coll Cardiol 67, 2802–2803.
    1. Werner N, Kosiol S, Schiegl T, Ahlers P, Walenta K, Link A, Bohm M & Nickenig G (2005). Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med 353, 999–1007.
    1. WHO (2019). WHO report on the global tobacco epidemic 2019. Geneva. .
    1. Wingfield D, Grodzicki T, Palmer AJ, Wells F, Bulpitt CJ & General Practice Hypertension Study Group (2005). Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens 19, 347–354.
    1. Zhao D, Aravindakshan A, Hilpert M, Olmedo P, Rule AM, Navas-Acien A & Aherrera A (2020). Metal/metalloid levels in electronic cigarette liquids, aerosols, and human biosamples: a systematic review. Environ Health Perspect 128, 036001.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅