These studies contribute to the growing body of evidence that e-cigarette users and combustible cigarette smokers suffer similar cardiovascular risks. Furthermore, it demonstrates that this cardiovascular risk is evident even in younger people with a shorter history of nicotine use.

People should be aware that combustible cigarettes and e-cigarettes both contain dangerous chemicals and addictive nicotine, which could be harmful to their cardiovascular systems and general health.

According to two separate analyses, adults who regularly used electronic nicotine delivery devices, or e-cigarettes, showed alarming changes in heart and blood vessel function and performed remarkably worse on exercise stress testing than people who did not use any nicotine products.

Two abstracts comparing vapers, smokers of conventional cigarettes, and non-users of nicotine products will be presented at the American Heart Association’s Scientific Sessions 2022 by researchers involved in the Cardiac and LUng E-cig Smoking (CLUES) Study.

Researchers at the University of Wisconsin carried out the CLUES study from March 2019 to March 2022. It was created to compare the short-term effects of cigarette smoking and vaping in habitual nicotine users to peers who did not use nicotine in any way.

Among the 395 study subjects were:

• 164 people admitted to exclusively using electronic cigarettes for an average of 4.1 years, and 80% disclosed using the most recent generation of vaping devices (average age of 27.4 years, 39% female, 86% reported white race); 117 participants who reported exclusively smoking traditional, combustible cigarettes for an average of 23 years (average age of 42.8 years, 44% female, 56% reported white race); and 114 adults who reported never smoking or vaping and who currently had negative urothelial cytokine
• Researchers measured blood pressure, heart rate, the diameter of the brachial artery in the arm, and heart rate variability before and up to 15 minutes after the participants either smoked or vaped in the first study. For those who claimed to have never smoked or vaped before, researchers compared pre- and post-test results to those collected 10 to 15 minutes apart.

The researchers found that compared to people who didn’t use nicotine, vapers and people who smoked regular cigarettes had:

• the heart rate increased more, which means their hearts were beating faster. People who vaped or smoked saw their heart rates go up by about 4 beats per minute (bpm), but people who said they didn’t use nicotine didn’t notice any change in their heart rate. Both systolic (top number) and diastolic (bottom number) blood pressure went up more. People who vaped or smoked saw their blood pressure go up from about 122/72 mm Hg to about 127/77 mm Hg, while people who had never used nicotine products saw no change in their blood pressure measurements.
• Following smoking or vaping, users of these nicotine-containing products also exhibited worse heart rate variability measurements and increased brachial artery constriction, which are signs of sympathetic nervous system activation. Sympathetic nerve system activates fight-or-flight. When a person is under stress or in danger, it becomes more active, raising blood pressure and heart rate as well as the heart’s desire for oxygen. It also causes arterial walls to become dysfunctional.

Lead study author Matthew C. Tattersall, said that there were alarming changes in blood pressure, heart rate, heart rate variability, and blood vessel tone (constriction) immediately after vaping or smoking. 

“These findings suggest worse cardiovascular disease risk factors right after vaping or smoking, and activation of the sympathetic nervous system may play a role in the adverse responses seen immediately after using e-cigarettes and after exercise testing 90 minutes later.”

In the second study, the same subjects participated who vaped and smoked were compared with the group of participants who did not smoke or use e-cigarettes to see how they did on exercise stress testing, which is known to predict cardiovascular disease outcomes. 

Stress tests on a treadmill were done about 90 minutes after people smoked or vaped, and about 90 minutes after people who said they didn’t use nicotine had rested.

Following the stress test, four outcome measures were gathered and examined:

• Metabolic equivalents (METS), a gauge of fitness or exercise capacity: A brisk walk burns 3–4 METS, or about 3–4 times as much energy as sitting still and quietly consumes in 1 MET. Lower METS values obtained during a stress test are linked to a higher cardiovascular risk.
• The rate-pressure product, or cardiac workload, is a metric used to assess how hard the heart is working during intense physical activity. A greater rate indicates that the heart can pump more forcefully.
• Heart rate reserve is a measurement of the difference between the resting heart rate and the expected maximum heart rate during exercise – i.e., how much reserve the heart can mobilize, with a higher reserve indicating greater cardiac fitness.
• 60-second heart rate recovery, a measurement of how quickly the heart rate recovers after exercise: the quicker the heart rate recovers, the better a person’s cardiac fitness and long-term cardiovascular outlook.

In comparison to the group who reported not using nicotine, people who smoked cigarettes and those who vaped performed considerably worse on each of the four activity criteria. Additionally, individuals who routinely smoked or vaped when compared to those who did not use nicotine:

had a lower maximum exercise testing score (peak METS; 9.8 for vapers, 9.3 for smokers, and 11.1 for never-vapers); a lower maximum cardiac workload; a lower heart rate reserve, indicating poorer fitness (87 percent for vapers, 85 percent for smokers, and 91 percent for never-vapers); and a slower heart rate recovery after completing the exercise test (25.2 bpm for people who vaped, 22.4 for people who smoked and 28.1 for people who did neither).

Even after controlling for age, sex, and race/ethnicity, the study’s lead author, Christina M. Hughey, said that vapers clearly underperformed their peers who did not use nicotine on all four exercise parameters. Even though they had been vaping for less years and were younger than smokers, their exercise performance was not noticeably different from that of those who smoked combustible cigarettes.

Principal investigator of the CLUES study James H. Stein, stated that the study’s findings “raise concerns about the potential harms of chronic use of electronic nicotine delivery systems, particularly for cardiovascular disease.” 

“We did not study the long-term effects of vaping, use of vaping as a smoking cessation aid or the effectiveness or safety of vaping in that context. However, these findings are concerning because they indicate vaping may increase cardiovascular risk. The message for people who smoke combustible cigarettes is the same as always – try to quit using tobacco and nicotine products and seek support from your physician and community to increase your chances of success.”

The CLUES Study was a case study that involved product observation. The results cannot establish a cause-and-effect relationship between the use of nicotine-containing goods and the cardiovascular measurements made because people were monitored and some outcomes were measured before and after product use.

The researchers were unable to directly compare the effects of vaping to smoking because the people who smoked in the studies were older, and had used nicotine-containing products for a lot longer (average use of 23 years for those who used combustible cigarettes vs. 4 years for those who used e-cigarette products), and were more likely to be from underrepresented races and ethnicities than those who vaped.

Most vapers were white adults, therefore results may not apply to other racial and ethnic groups.

Image Credit: Michael Nagle/Bloomberg via Getty Images

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