The cardiovascular consequences of electronic cigarette smoking: a narrative review

ABSTRACT

Introduction

E-cigarettes have emerged as a popular alternative to traditional tobacco smoking in recent years. Despite their growing popularity, concerns have arisen regarding the cardiovascular implications of e-cigarette use.

Areas covered

This narrative review aims to highlight the latest evidence on the impact of e-cigarettes on cardiovascular health.

Expert opinion

Numerous studies have demonstrated that e-cigarette use can lead to acute adverse cardiovascular effects. Inhalation of e-cigarette aerosols exposes users to a wide range of potentially harmful substances that have been implicated in critical pathophysiologic pathways of cardiovascular disease, namely endothelial dysfunction, oxidative stress, inflammation, sympathetic overdrive, and arterial stiffness. While long-term epidemiological studies specifically focusing on the cardiovascular effects of e-cigarettes are still relatively scarce, early evidence suggests a potential association between e-cigarette use and an increased risk of adverse cardiovascular events. However, it is essential to recognize that e-cigarettes are relatively new products, and the full extent of their long-term cardiovascular impact has not been fully elucidated. In the meantime, promoting tobacco cessation strategies that are evidence-based and regulated, along with rigorous monitoring of e-cigarette use patterns and associated health outcomes, are essential steps in safeguarding cardiovascular health in the face of this emerging public health challenge.

KEYWORDS:

• Electronic cigarette
• cardiovascular disease
• smoking
• inflammation
• sympathetic nervous system

Article highlights

• E-cigarettes have emerged as a popular alternative to traditional tobacco smoking in recent years.

• Inhalation of e-cigarette aerosols exposes users to a wide range of potentially harmful substances that have been implicated in cardiovascular disease pathophysiology.

• The main pathways involved in e-cigarette induced cardiovascular toxicity are inflammation, oxidative stress, endothelial dysfunction, sympathetic overdrive, and stimulation of a prothrombotic state.

• Observational studies suggest an association of e-cigarette smoking with cardiovascular outcomes.

• E-cigarette smoking cannot be considered harmless toward cardiovascular health.

• The public should be aware of the potential cardiovascular risks associated with their use and utilize evidence-based approaches to smoking cessation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.