Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction

Q: What are the key findings of this study?

Acute use of 4th generation electronic cigarettes with 5% nicotine significantly increased heart rate by 8.1 beats/min compared to non-nicotine e-cigarettes in exclusive e-cigarette users.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Healthy individuals (tobacco/e-cigarette users and nonusers) (n=110). Intervention: 4th generation electronic cigarette with 5% nicotine (EC5) vs. Electronic cigarette with 0% nicotine (EC0). Primary outcome: Change in heart rate (beats/min) after acute exposure (p=<0.0001).

Q: What does this research mean for the field?

Acute use of 4th generation electronic cigarettes with 5% nicotine significantly increases heart rate by 8.1 beats/min compared to non-nicotine e-cigarettes, indicating that nicotine is the primary instigator of acute adverse cardiovascular changes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Randy Nguyen; Isabelle Ruedisueli; Karishma Lakhani; Joyce Ma; Holly R. Middlekauff

doi:10.1152/japplphysiol.00067.2023

January 11, 2024Journal of Applied PhysiologyOpen Access

Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction

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Key result

Acute nicotine e-cigarette use raises heart rate by ~8 bpm versus non-nicotine devices.

P<0.0001
n=110

Why the study?

Does acute exposure to nicotine-containing 4th generation electronic cigarettes increase heart rate, blood pressure, and alter heart rate variability compared to non-nicotine controls in healthy adults?

Study Design

Type

RCT (n=110)

Randomization

Randomized crossover

Multicenter

No

Structured PICO

Does acute exposure to nicotine-containing 4th generation electronic cigarettes increase heart rate, blood pressure, and alter heart rate variability compared to non-nicotine controls in healthy adults?

P

Population

110 healthy male and female participants between the ages of 21 and 45 yr with no known health problems (no high blood pressure, heart disease, diabetes, obesity, depression, or prescription medications). Categorized into nonusers (n=41), exclusive electronic cigarette users for >=12 months (n=34), and tobacco cigarette smokers including dual users for >=12 months (n=35).

I

Intervention

Acute exposure to a 4th generation electronic cigarette with 5% nicotine (EC5) or a commercially available tobacco cigarette with nicotine (TCN).

C

Comparator

Acute exposure to a straw-control, an electronic cigarette with 0% nicotine (EC0), or a research tobacco cigarette without nicotine (TC0).

O

Outcome

Acute changes in hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure) and heart rate variability (HRV) measured after a 5-min rest period following exposure.surrogate

Main Result

Absolute Event Rate: 8.1% vs -0.4%

p-value: p=<0.0001

Acute exposure to nicotine-containing 4th generation electronic cigarettes produces similar adverse hemodynamic effects and abnormal heart rate variability patterns as combusted tobacco cigarettes, questioning their safety as a harm reduction strategy.

Limitations

Only one brand and flavor of 4th generation device was used, limiting generalizability across products.
History of electronic and tobacco cigarette use was self-reported.
A delay of 10 to 15 minutes from tobacco product exposure to postexposure recording may have missed early and transient hemodynamic changes.
Too few dual users were enrolled to allow for a separate analysis as a distinct group.

Implication

Questions nicotine e-cigarettes as harm reduction; extends RCT evidence of acute CV effects matching tobacco.

Abstract

We found that nicotine, not the non-nicotine constituents in tobacco cigarette (TC) or electronic cigarette (EC) emissions, may be the instigator of the acute, potentially adverse, changes in hemodynamics and heart rate variability (HRV) that were recorded several minutes after tobacco product use. Furthermore, acute EC use produced an abnormal HRV pattern associated with increased cardiac risk in people who chronically smoke ECs and produced similar hemodynamic increases compared with acute TC use in people who chronically smoke TCs, including people who are dual users.

Discussion

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Cite This Study

Nguyen et al. (2024) conducted an RCT in Healthy individuals (tobacco/e-cigarette users and nonusers) (n=110). 4th generation electronic cigarette with 5% nicotine (EC5) vs. Electronic cigarette with 0% nicotine (EC0) was evaluated on Change in heart rate (beats/min) after acute exposure (p=<0.0001). Acute use of 4th generation electronic cigarettes with 5% nicotine significantly increased heart rate by 8.1 beats/min compared to non-nicotine e-cigarettes in exclusive e-cigarette users.

synapsesocial.com/papers/6a19266891a7b6a296d949cc https://doi.org/10.1152/japplphysiol.00067.2023

View Full Paper

Ask AI

Bookmark

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Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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