ENDS Cardiovascular System

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Studies, Surveys, Papers, and Case Studies

  • Sometimes it's necessary to view the PDF version to access the full study.
  • This page is for referencing the possible benefits of ENDS products vs. smoking cigarettes from a Cardiovascular System standpoint. (Electronic Nicotine Delivery Systems are also known as vapor technology, ecigarettes, ecigs, EVP, etc.)
  • If you'd prefer someone else to add a study to a topic, there is a subject section called "Suggested studies to add to this page". You may put the link in that section for one of the regular page editors to address.
  • If you'd like to help add content to this page, formatting instructs are at the bottom of the page.

ENDS - (Not Ingredient Specific)

2020: Effects of electronic cigarette on platelet and vascular function after four months of use

  • Electronic Cigarette vaping for four months has a neutral effect on platelet aggregation of healthy smokers. Continuation of tobacco cigarette smoking further deteriorates platelet function during 4 months of use.
  • Electronic cigarette vaping improves arterial elastic properties and oxidative stress after 4 months of use. Tobacco cigarette smoking causes further impairment of arterial elasticity and oxidative stress during 4 months of use.
  • Citation: Ikonomidis, I., Katogiannis, K., Kostelli, G., Kourea, K., Kyriakou, E., Kypraiou, A., Tsoumani, M., Andreadou, I., Lambadiari, V., Plotas, P., Thymis, I., & Tsantes, A. E. (2020). Effects of electronic cigarette on platelet and vascular function after four months of use. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association, 141, 111389. https://doi.org/10.1016/j.fct.2020.111389

2020: Differential Effects of Tobacco Cigarettes and Electronic Cigarettes on Endothelial Function in Healthy Young People

  • Endothelial dysfunction, as measured by flow mediated vasodilation(FMD) is a predictor of future atherosclerosis and adverse cardiovascular events, and is impaired in tobacco cigarette (TC) smokers.
  • Impaired FMD in TC smokers is most likely attributable to non-nicotine toxicants in TC smoke, since an equivalent increase in plasma nicotine from the EC did not lead to acute impairment in FMD.
  • FMD was significantly impaired after smoking one TC, but not after vaping an equivalent "dose"(estimated plasma nicotine) of an e-cigarette (EC), consistent with the notion that non-nicotine constituents in TC smoke mediate the impairment.
  • However, there is increasing scientific literature that supports the notion that ECs, although not harmless, may be less harmful than TC smoking for cardiovascular risk.
  • Acknowledgement: This work was supported by Tobacco-Related Disease Research Program Grants TRDRP 23XT-0006H (to H.R.M.), 25IR-0024H (to H.R.M.), and TRDRP 28IR-0065 (H.R.M.) and by National Institutes of Health, National Center for Advancing Translational Science UCLA CTSI Grant UL1TR001881.
  • Citation: Haptonstall KP, Choroomi Y, Moheimani R, Nguyen K, Tran E, Lakhani K, Ruedisueli I, Gornbein J, Middlekauff HR. Differential effects of tobacco cigarettes and electronic cigarettes on endothelial function in healthy young people. Am J Physiol Heart Circ Physiol. 2020 Sep 1;319(3):H547-H556. doi: 10.1152/ajpheart.00307.2020. Epub 2020 Jul 31. PMID: 32734819; PMCID: PMC7509270.

2019: Global Forum on Nicotine (GFN) The effect of electronic nicotine delivery systems (ends) and new tobacco products on the risk of cardiovascular disease in people with high tobacco dependence

Switching to ENDS/NTPs and nicotine delivery with cigarette smoke’s harmful effects elimination does not interrupt blood oxygen transport function which allows to avoid vessels endothelial damage. The obtained results show significantly less harmful influence of ENDS/NTPs on cardio-vascular function if compared to tobacco smoke and confirm the possibility to consider them as harm reduction products for smokers who do not want or are not ready to quit smoking completely. Poster that goes with the study 2017 Article about this study

2019: Letter

that debunks this study: Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health

2019: Is E-Cigarette Use associated with coronary heart disease and myocardial infarction?

Insights from the 2016 and 2017 National Health Interview Surveys The pooled analysis of the 2016 and 2017 NHIS showed no association between e-cigarette use and MI or CHD. The associations between established risk factors, including smoking, and both conditions were remarkably consistent. The inconsistent associations observed in single-year surveys and the cross-sectional design of the NHIS cannot substantiate any link between e-cigarette use and an elevated risk for MI or CHD. Longitudinal studies are needed to explore the effects of e-cigarette use on cardiovascular disease.

2019: (November 15) Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes

(Jacob George, MD, Muhammad Hussain, MSc, Thenmalar Vadiveloo, PhD, Sheila Ireland, BSc, Pippa Hopkinson, BSc, Allan D.Struthers, MD, Peter T. Donnan, PhD, Faisel Khan, PhD, Chim C.Lang, MD E-cigarette (EC) use is increasing exponentially worldwide. The early cardiovascular effects of switching from tobacco cigarettes (TC) to EC in chronic smokers is unknown. Meta-analysis of flow-mediated dilation (FMD) studies indicate 13% lower pooled, adjusted relative risks of cardiovascular events with every 1% improvement in FMD.

2019: Electronic cigarettes and cardiovascular health: what do we know so far?

Though they may not be as harmless as previously proposed, it seems likely that on the spectrum of tobacco products, ECs are less harmful than TCs, and there is increasing evidence that ECs may help promote TC cessation. As such, ECs may be helpful for risk reduction.

2017: Have combustible cigarettes met their match? The nicotine delivery profiles and harmful constituent exposures of second-generation (G2) and third-generation (G3) electronic cigarette users

While not harmless, electronic cigarettes (e-cigarettes) have demonstrated a much more favourable toxicological profile than combustible cigarettes—the worldwide leading cause of preventable death. Average eCO levels (ppm) were significantly higher in smokers than in e-cigarette users. Compared with cigarettes, G2 and G3 e-cigarettes resulted in significantly lower levels of exposure to a potent lung carcinogen and cardiovascular toxicant.

2017: Electronic cigarette smoking increases of arterial stiffness and oxidative stress to a lesser extent than a single normal cigarette: an acute and chronic study

Electronic cigarette smoking causes a smaller increase of arterial stiffness and oxidative stress, compared to a single normal cigarette in an acute setting. Replacement of normal cigarettes by a moderate nicotine concentration electronic cigarette results in improved aortic elasticity and oxidative stress within 1 month.

2016: Cigarette smoke but not electronic cigarette aerosol activates a stress response in human coronary artery endothelial cells in culture

Human coronary artery endothelial cells show a biological response to cigarette smoke. This response was not seen following exposure to e-cigarette aerosol. Using e-cigarettes instead of cigarettes may reduce immediate cardiovascular harms.

2013: Chronic Idiopathic Neutrophilia in A Smoker, Relieved after Smoking Cessation with the Use of Electronic Cigarette: a Case Report

A male Caucasian patient, born in 1977, presented in September 2005 with asymptomatic elevation of white blood cell and neutrophil count, and mildly-elevated C-reactive protein levels. He was a smoker since 1996 and was treated with 20 mg/day of simvastatin since 2003 due to hyperlipidemia. Clinical examination, and laboratory and imaging investigations ruled out any infectious, haematological, rheumatological, or endocrine conditions. He was followed-up regularly and was advised to stop smoking. He had 2 unsuccessful attempts to quit smoking; one was unassisted and the second was performed with the use of both varenicline and nicotine replacement therapy (patches). During the subsequent 6.5 years, his leukocyte and C-reactive protein levels were repeatedly elevated; the condition was consistent with chronic idiopathic neutrophilia. In February 2012, he started using electronic cigarettes and he managed to quit smoking within 10 days. After 6 months, laboratory examination showed normalized leukocyte count and C-reactive protein levels, confirmed immediately by a second laboratory and by repeated tests after 1 and 2 months. Smoking cessation with the use of electronic cigarette led to reversal of chronic idiopathic neutrophilia. The daily use of electronic cigarette may help preserve the beneficial effects of smoking cessation.

2012: Acute effects of electronic and tobacco cigarette smoking on complete blood count

Active and passive tobacco cigarette smoking increased white blood cell, lymphocyte, and granulocyte counts for at least one hour in smokers and never smokers. Active and passive tobacco cigarette smoking increase the secondary proteins of acute inflammatory load for at least one hour. It is concluded that acute active and passive smoking using the e-cigarettes tested in the current study does not influence CBC indices in smokers and never smokers. The results demonstrated that CBC indices remained unchanged during the control session and the active and passive e-cigarette smoking sessions.

2010: A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects

Heart rate increased from an average (SD) of 65.7 (10.4) bpm at baseline to a peak of 80.3 (10.9) bpm five minutes after the first administration under the tobacco cigarette condition. No significant changes in heart rate were observed for the e-cigarette or sham conditions. Under these acute testing conditions, neither of the electronic cigarettes exposed users to measurable levels of nicotine or CO, although both suppressed nicotine/tobacco abstinence symptom ratings.

Flavors (Flavours)

2019 Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function

  • Our data indicate that flavorings typically present in e-cig refill liquids do not cause endothelial dysfunction that would result in impaired vasodilation upon acute exposure. In contrast, most of the tested compounds caused endothelium-independent vasorelaxation, albeit at fairly high concentrations that appear to exceed by far the plasma concentrations expected to occur upon vaping flavored liquids.
  • PDF Version
  • Citation: Wölkart G, Kollau A, Stessel H, Russwurm M, Koesling D, Schrammel A, et al. (2019) Effects of flavoring compounds used in electronic cigarette refill liquids on endothelial and vascular function. PLoS ONE 14(9): e0222152. https://doi.org/10.1371/journal.pone.0222152
  • Acknowledgement: This work was supported by the Austrian Science Fund (FWF) grant [P24946] to BM.

2013: Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour (Vapor) Extract on Cultured Myocardial Cells

  • Smoking is an important risk factor for cardiovascular disease and cigarette smoke (CS) has well-established cytotoxic effects on myocardial cells. The purpose of this study was to evaluate the cytotoxic potential of the vapour of 20 EC (e-cigarette) liquid samples and a “base” liquid sample (50% glycerol and 50% propylene glycol, with no nicotine or flavourings) on cultured myocardial cells. Included were 4 samples produced by using cured tobacco leaves in order to extract the tobacco flavour. Methods: Cytotoxicity was tested according to the ISO 10993-5 standard.
  • In conclusion, from 20 commercially-available EC liquids that were tested in vapour form, four were found to be cytotoxic on cultured cardiomyoblasts. Cytotoxicity was mainly observed in most (but not all) samples produced by using tobacco leaves, while one sample using food-approved flavoring was marginally cytotoxic. EC vapour production by using higher-voltage devices caused a decrease in cell survival. Overall, EC vapour extracts showed significantly higher cell viability compared to CS extract, based on a realistic-use rather than a standardized comparative level of exposure. This supports the concept that ECs may be useful as tobacco harm reduction products.
  • PDF Version
  • Citation: Farsalinos, K., Romagna, G., Allifranchini, E., Ripamonti, E., Bocchietto, E., Todeschi, S., … Voudris, V. (2013). Comparison of the Cytotoxic Potential of Cigarette Smoke and Electronic Cigarette Vapour Extract on Cultured Myocardial Cells. International Journal of Environmental Research and Public Health, 10(10), 5146–5162. doi:10.3390/ijerph10105146
  • Acknowledgement: The study was funded in part by the Greek Association of E-cigarette Businesses (SEEHT).


2017: Sympathomimetic Effects of Acute E‐Cigarette Use: Role of Nicotine and Non‐Nicotine Constituents

The acute sympathomimetic effect of e‐cigarettes is attributable to the inhaled nicotine, not to non‐nicotine constituents in e‐cigarette aerosol Oxidative stress, as estimated by plasma paraoxonase, did not increase following any of the 3 exposures.

2016: Cardiovascular toxicity of nicotine: Implications for electronic cigarette use

Studies of nicotine medications and smokeless tobacco indicate that the risks of nicotine without tobacco combustion products (cigarette smoke) are low compared to cigarette smoking, but are still of concern in people with cardiovascular disease. Electronic cigarettes deliver nicotine without combustion of tobacco and appear to pose low-cardiovascular risk, at least with short-term use, in healthy users.

PAGE EDITORS - Please only add Studies, Surveys, Papers in this format to keep page organized

  • Topic
  • Year (list new to old) Name of Study (In link format to the study)
  • Note here if animal study (leave blank if not)
  • Brief Summary
  • Link to PDF Version
  • Citation
  • Acknowledgements (funded by, helped by)
  • Keywords
  • Other

Suggested studies to add to this page

2021: Short-Term Cardiovascular Effects of E-Cigarettes in Adults Making a Stop-Smoking Attempt: A Randomized Controlled Trial

2021: Increased Expression of Proatherogenic Proteins in Immune Cell Subtypes in Tobacco Cigarette Smokers But Not in Electronic Cigarette Vapers

  • In this study, we showed that tobacco cigarette smoking, but not electronic-cigarette vaping, is associated with increased expression of major proteins in the toll-like receptor 4 (TLR4) inflammasome-interleukin (IL)-6 signalling axis in monocyte subtypes and T cells.
  • These findings implicate the non-nicotine, pro-oxidant toxicants in tobacco cigarette smoke as instigators of increased expression of key proteins in the TLR4-inflammasome-IL-6 axis that contribute to atherogenesis.
  • These data support additional investigations into the role of ECIGs as part of a harm reduction strategy for adults addicted to TCIGs who are unwilling or unable to quit.
  • "proatherogenic" = promoting fatty plaques in the arteries (which is bad)
  • Acknowledgement: This work was supported by the Tobacco-Related Disease Research Program under the contract number TRDRP 28IR-0065 (H.R.M.), by Univeristy of California Office of the President under the contract number R00RG2749 Emergency COVID-19 Research Seed Funding (H.R.M.), and by the National Institutes of Health National Center for Advancing Translational Science University of California Los Angeles Clinical and Translational Science Institute grant number L1TR001881. This work was also supported in part by National Institutes of Health grants R01AG059501, R03AG059462 (T.K.). The flow cytometry machine used in the study was purchased through the University of California Los Angeles Center for AIDS Research (P30AI28697) grant.
  • Citation: Kelesidis, T., Zhang, Y., Tran, E., Sosa, G., & Middlekauff, H. R. (2021). Increased Expression of Proatherogenic Proteins in Immune Cell Subtypes in Tobacco Cigarette Smokers But Not in Electronic Cigarette Vapers. The Canadian journal of cardiology, 37(8), 1175–1180. https://doi.org/10.1016/j.cjca.2021.05.006

More Information

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