Impact of Electronic Cigarettes on the Cardiovascular System

T obacco smoking is a major public health threat for both smokers and nonsmokers.There is accumulating evidence demonstrating that smoking causes several human diseases, including those affecting the cardiovascular system.Indeed, tobacco smoking is responsible for up to 30% of heart disease-related deaths in the United States each year. 1 This is the single most preventable risk factor related to the development of cardiovascular disease, bringing about a trend toward tobacco harm reduction that started years ago. 2 As tobacco usage declined over time in the United States, industries introduced an alternative known as electronic cigarettes (e-cigarettes) claiming they were a healthier alternative to tobacco smoking. 3ince then, the number of e-cigarette users has increased significantly because of the perception that they serve as a healthy substitute to tobacco consumption with minimal or no harm, a lack of usage regulations (although that has now changed), and the appealing nature of these devices, among other reasons. 4Consequently, e-cigarettes became the most commonly used smoking products, especially among youth, with more than a 9-fold increase in usage from 2011 to 2015. 5 Based on these considerations, it is clear that there are many unanswered questions regarding the overall safety, efficacy of harm reduction, and the long-term health impact of these devices.Besides their potential negative health effects on users, there is increasing evidence that e-cigarettes emit considerable levels of toxicants, such as nicotine, volatile organic compounds, and carbonyls, in addition to releasing particulate matter (PM). 6,7Thus, they possess a potential harm to nonusers either through secondhand or thirdhand exposure.This is especially the case in vulnerable populations, such as children, elderly, pregnant females, and those with a history of cardiovascular disease. 8Thus, it is critical to establish e-cigarettes' short-and long-term health effects on both users and nonusers.In this review, we will discuss the current state of literature regarding the potential negative cardiovascular effects of direct/active and passive e-cigarette exposure.Furthermore, we will review the possible impact of the individual constituents of the e-cigarette on hemodynamics and their contribution to the development of cardiovascular disease.The notion that e-cigarettes may negatively impact the cardiovascular system should uncover new avenues of research focused on establishing and understanding the safety of e-cigarette usage on human health.