Key result
E-cigarette smoking acutely increases MAP by ~13% and alters sympathetic nerve activity similarly to tobacco.
Why the study?
Data are scarce on the impact of e-cigarettes, proposed as less harmful alternatives to tobacco cigarettes, on the cardiovascular system and sympathetic drive.
Does e-cigarette smoking acutely increase blood pressure and sympathetic nerve activity compared to sham smoking in healthy habitual smokers?
RCT (n=10)
Placebo controlled
Random order
Does e-cigarette smoking acutely increase blood pressure and sympathetic nerve activity compared to sham smoking in healthy habitual smokers?
p-value: p=<0.05
E-cigarette smoking acutely increases blood pressure and alters sympathetic nerve activity similarly to tobacco smoking, highlighting its potential cardiovascular harm.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“They can cause your heart to race. They can cause the blood vessels to spasm, and when that happens, it raises your blood pressure and can actually cause heart attacks by causing spasms of the coronary artery.”
“A growing body of research shows that people who use e-cigarettes can be exposed to chemicals that can harm the heart and blood vessels.”
“It is not water vapor, and they are not harmless.”
Acute e-cigarette use raises MAP and sympathetic activity like tobacco; challenges reduced-harm assumptions and extends causal RCT evidence.
Background/Introduction Tobacco cigarette smoking is related with atherosclerosis progression, blood pressure increase and changes in sympathetic nerve activity. However, there are scarce data on the impact of e-cigarettes that have been proposed as less harmful alternatives on the cardiovascular system and sympathetic drive. Purpose This study aimed to assess the acute effects of tobacco cigarettes, e-cigarettes and sham smoking on blood pressure and sympathetic nervous system in healthy subjects. Methods We studied 10 normotensive male habitual smokers (mean age 33 years, body mass index: 24.1 kg/m2, office blood pressure=117/72 mmHg) free of cardiovascular disease. The study design was randomized and placebo controlled with 3 experimental sessions (sham smoking, tobacco cigarette smoking, and e-cigarette smoking) in random order, each session on a separate day. Subjects smoked 2 tobacco cigarettes containing 1.1 mg nicotine or simulate smoking (sham smoking) with the 2 cigarettes separated by 5 minutes, while 45 minutes after finishing the second cigarette, subjects smoked a third cigarette or sham cigarette. Additionally, participants smoked e-cigarettes for a period of 5 and 30 minutes. In all occasions, sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) (baroreflex-dependent) and skin sympathetic nerve activity (SSNA) (baroreflex-independent) based on established methodology (microneurography). Results After the first, second and third tobacco cigarette smoking there was markedly and significantly increase in mean arterial pressure (by 11.2±1.4%, 12.3±1.3% and 13.1±1.4%, respectively, p<0.05 for all) and heart rate (by 25.1±3.7%, 26.3±2.7% and 25.9±3.7%, respectively, p<0.05 for all). Similarly e-cigarette smoking at 5 and 30 minutes was accompanied by augmentation of mean arterial pressure (by 10.9±1.2% and 12.8±1.4%, respectively, p<0.05 for both) and heart rate (by 22.5±3.3% and 23.9±3.8%, respectively, p<0.05 for both). Regarding the effect on sympathetic nervous system, the first, second and third tobacco cigarette smoking was accompanied by lower MSNA (by 28.1±4.4%, 29.6±5.3% and 30.1±5.2%, respectively, p<0.05 for all), whereas SSNA was increased (by 98.2±19.4%, 100.2±22.7% and 101.5±21.6%, respectively, p<0.05 for all). Additionally, e-cigarette smoking at 5 and 30 minutes caused a decrease in MSNA (by 26.9±3.6%, and 28.3±5.1%, respectively, p<0.05 for both), and an augmentation in SSNA (by 97.9±20.1% and 100.9±20.6%, respectively, p<0.05 for both). Sham smoking was devoid of any effects on blood pressure, MSNA and SSNA. Conclusions E-cigarette smoking acutely increases blood pressure and has a detrimental effect on sympathetic nerve activity regulation similar to tobacco smoking in healthy subjects. Our findings underscore the negative impact of e-cigarettes on cardiovascular and autonomic nervous system and could aid further recommendation in their use.
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Dimitriadis et al. (2019) conducted an RCT in Healthy habitual smokers (n=10). E-cigarette and tobacco cigarette smoking vs. Sham smoking was evaluated on Blood pressure and sympathetic nerve activity (MSNA and SSNA) (p=<0.05). E-cigarette smoking acutely increased mean arterial pressure by up to 12.8% and altered sympathetic nerve activity similarly to tobacco smoking (p<0.05 for all), whereas sham smoking had no effect.
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