Smoking while wearing mask may promote vascular dysfunction, worsening CV health
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The re-inhalation of carbon monoxide among smokers while wearing a mask promotes vascular dysfunction and may worsen CV health, according to findings from a single-center study.
In an analysis of adults who were smokers of conventional or noncombustible cigarettes but free of CVD at baseline, researchers found that all vascular markers, including pulse wave velocity, augmentation index and systolic BP, were higher after 8 hours of wearing a mask compared with periods of no mask wearing, whereas there were no differences observed in nonsmokers.
“The study suggests that smoking any tobacco product has become even more hazardous during the COVID-19 pandemic because of the need to wear a mask for long hours,” Ignatios Ikonomidis, MD, PhD, FESC, assistant professor in cardiology at Attikon Hospital, of the National and Kapodistrian University of Athens, Greece, said in a press release. “Prior research has shown that impaired vascular function is linked with heart problems and premature death.”
For 1 month, Ikonomidis and colleagues analyzed data from 40 smokers of conventional cigarettes, 40 smokers of heat-no-burn cigarettes and 40 nonsmokers of a similar age and sex who were medical personnel in a tertiary care hospital. The mean age of participants was 45 years; 28% were men. Researchers measured exhaled carbon monoxide in parts per million (ppm) with a validated device, as well as pulse wave velocity (PWV), augmentation index adjusted for heart rate, and central systolic BP by a validated pulse wave analysis device. Baseline measurements were performed early in the morning after a night of sleep without any use of a mask. Researchers then randomly assessed participants a second time at the end of an 8-hour morning shift wearing a mask at a hospital or at the end of an 8-hour morning period without wearing a mask during out-of-hospital activities. Participants then crossed over to a third assessment either at the end of an 8-hour period without a mask out of the hospital after a morning shift, or after an 8-hour period wearing a mask during an afternoon hospital shift. Researchers instructed participants not to smoke for at least 1 hour before measurements to avoid any acute effect of smoking.
The findings were published in a research letter in the European Journal of Preventive Cardiology.
Compared with baseline measurements, the increase in carbon monoxide among conventional cigarette smokers was greater while wearing vs. not wearing a mask for 8 hours, with an absolute difference of 9.45 ppm (95% CI, 8.01-10.88) vs. 4.15 ppm (95% CI, 3.15-5.14; P < .001). Among noncombustible cigarette smokers, exhaled carbon monoxide increased from 1.15 ppm at baseline to 1.43 ppm with no mask and 2.2 ppm with a mask. Among nonsmokers, exhaled carbon monoxide did not differ between the baseline, no-mask and mask periods.
For conventional cigarette smokers and noncombustible cigarette smokers, all vascular markers were increased after 8 hours with or without mask wearing compared with baseline measurements (P < .05). In nonsmokers, the use of a mask did not affect vascular markers (P > .05).
The researchers noted a follow-up period is required to detect whether the increase in the measured markers while wearing a mask is related with a higher incidence of CVD.
“Compared to smokers of combustible cigarettes, noncombustible cigarette users had lower baseline carbon monoxide levels and smaller increases in vascular damage while wearing a mask,” Ikonomidis said in the release. “Nevertheless, the findings show that smoking any tobacco product while wearing a mask may further impair blood vessel function compared to non-mask periods, at least partly due to greater re-inhalation of carbon monoxide and/or vapor rich in nicotine. The results provide even more impetus for all smokers to kick the habit.”
Perspective
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Johanna Contreras, MD, MSc, FACC, FAHA, FASE
It is interesting to see these markers of vascular dysfunction rise so quickly after cigarette exposure. These outcomes will also vary depending on how long the person has been smoking and how much the person smokes currently. Still, it is exciting to show that even within a short period of using tobacco, when you concentrate the air force by wearing a mask, you see the inflammatory markers going up.
It would be interesting to look at the findings chronically and also among people with risk factors for CVD, as all of these participants were free of CVD risk factors at baseline. Are the parameters persisting in going up after cigarette exposure over time, and is there a higher incidence of CVD among smokers wearing masks? These findings demonstrate that there is a rise in inflammatory markers that can be quantified just hours after cigarette exposure and should encourage people to want to stop smoking to improve their health.
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