E-cigarette use lowers lung function, heightens blood pressure, heart rate

Key takeaways:

• Electronic nicotine delivery system use negatively impacted measures of cardiovascular and pulmonary health.
• Worsened measures included blood pressure, heart rate, FEV₁, exercise tolerance and more.

Following 15-minute use of an electronic nicotine delivery system, or ENDS, lung function fell and blood pressure and heart rate rose in long-term users vs. nonusers, according to results published in CHEST.

“One episode of ENDS use is associated with acute worsening of cardiovascular and pulmonary health indexes among long-term ENDS users,” Matthew C. Tattersall, DO, MS, associate professor of cardiovascular medicine at University of Wisconsin, and colleagues wrote.

In an observational challenge study, Tattersall and colleagues assessed 164 exclusive ENDS users (mean age, 27.4 years; 39% women; 86% white), 117 exclusive cigarette users (mean age, 42.8 years; 44.4% women; 55.6% white) and 114 individuals who did not report smoking or vaping (mean age, 30.8 years; 50% women; 69.3% white) to compare measures of cardiovascular and pulmonary health between the groups after 15-minute product use.

During the 15-minute use period, individuals who did not smoke or vape rested.

Notably, median product use length was greater in the cigarette cohort compared with the ENDS cohort (21 years vs. 4 years), and these individuals had poorer baseline measures of lung function (FEV₁ and forced midexpiratory flow at 25% to 75% of FVC [FEF_25-75]).

Researchers observed a significantly higher number of puffs taken during the 15-minute use period among cigarette users vs. ENDS users (median, 14 puffs vs. 9 puffs; P < .001).

Between the group of exclusive ENDS users and the group of individuals who did not use tobacco or vape, three cardiovascular measures significantly rose following 15-minute product use in the ENDS cohort: systolic blood pressure (BP; adjusted mean difference, 5.6 mm Hg; 95% CI, 4.4-6.8 vs. 2.3 mm Hg; 95% CI, 0.8-3.8), diastolic BP (4.2 mm Hg; 95% CI, 3.3-5 mm Hg vs. 2 mm Hg; 95% CI, 1.1-3) and heart rate (HR; 4.8 beats/minute; 95% CI, 4-5.6 beats/minute vs. –1.3 beats/minute; 95% CI, –2.2 to –0.3).

Researchers noted comparable, significant findings to those above when evaluating cigarette users vs. individuals who did not report smoking or vaping.

Individuals using ENDS vs. no tobacco or vape products also had significantly worse brachial artery diameters (–0.011 cm; 95% CI, –0.013 to 0.009 cm vs. –0.006 cm; 95% CI, –0.004 to –0.009), time-domain heart rate variability (–7.2 ms; 95% CI, –10.5 to –3.7 vs. 3.6 ms; 95% CI, 1.6-9.3) and FEV₁ (–4.1; 95% CI, –5.4 to –2.8 vs. –1.1; 95% CI, –2.7 to 0.6).

With regard to these three measures between cigarette users and non-tobacco/vaping users, researchers observed decreased values in the cigarette cohort.

Both brachial artery flow-mediated dilation and standing heart rate variability did not significantly differ between the three cohorts, according to researchers.

Following the 15-minute use period, the FEV₁ to FVC ratio and FEF_25-75 significantly decreased to a larger extent in the ENDS cohort vs. the non-user cohort and the cigarette cohort.

In terms of exercise, researchers observed impaired performance among ENDS users when compared with non-users, with significantly decreased metabolic equivalents (METS; adjusted mean difference, 1.28 METs; 95% CI, 0.73-1.83) and 60-second heart rate recovery (adjusted mean difference, 2.9 beats/minute; 95% CI, 0.7-5) found in this cohort.

Peak rate-pressure product and heart rate reserve were also significantly lower in the ENDS cohort vs. the non-user cohort. Between the cigarette cohort and the non-user cohort, researchers noted worse exercise findings among cigarette users.

“ENDS users showed acute worsening of BP, HR and [heart rate variability], as well as vasoconstriction, impaired exercise tolerance and increased airflow obstruction after using ENDS compared with control participants,” Tattersall and colleagues wrote. “These findings raise concerns about the potential harms of contemporary ENDS.”