November 15, 2017

Stanton A. Glantz, PhD

More evidence that e-cigarettes are as bad as cigs in terms of heart disease risk

Mark Olfert and his colleagues recently published “Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice” in Journal of Applied Physiology.  In this study they exposed mice to e-cigarette aerosol for 8 months and found changes in their blood vessels that indicate heightened heart disease risk.  (These results are consistent with short-term studies in humans show that people who use e-cigarettes immediately have compromised functioning of their blood vessels.)   The effects were comparable to those found in mice exposed to cigarette smoke.
 
Interestingly, they did not find effects on lung function, which differs from earlier work.
 
In any event, this paper adds to the strong and consistent case that e-cigarettes use brings substantial cardiovascular risk.  Heart and vascular disease accounts for around half of smoker deaths. 
 
Here is the abstract:
 
Proponents for electronic cigarettes(E-cigs) claim they are a safe alternative to smoking tobacco-based cigarettes,however little is known about the long-term effects of E-cig vapor exposure on vascular function.The purpose of this study was to determine the cardiovascular consequences of chronic E-cig exposure. Female mice (C57Bl/6 background strain)were randomly assigned to chronic daily exposure of E-cig vapor, standard cigarette smoke(using 3R4F-reference-cigarette), or filtered-air(N=15/group). Respective whole-body exposures consisted of 4 x 1-hour exposure blocks, separated by 30-minute intervals of fresh air breaks, resulting in intermittent daily exposure for a total of 4h/day, 5days/week for 8-months. Non-invasive ultrasonography was used to assess cardiac function and aortic stiffness (pulse wave velocity)at 3 times points (before, during, after chronic exposure). Upon completion of the 8-month exposure, ex-vivo wire tension myograph and force transduction measured changes in aortic tension in response to vasoactive inducing compounds. Aortic stiffness increased 2.5- and 2.8-times greater in E-cig and conventional tobacco-cigarettes,respectively, compared to filtered-air exposed control mice(p  
The full citation is Olfert M, et al.   Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice.  J Appl Physiol (1985). 2017 Nov 2:jap.00713.2017. doi: 10.1152/japplphysiol.00713.2017. [Epub ahead of print].  It is available here.

Comments

Comment: 

I am a committed e-cigarette user who uses my e-cigarette regularly every day. I puff on my e-cigarette anywhere between 400 and 600 puffs per day. My puff length is typically between 2 and 3 seconds. Even if I double my puff length (6s) and use the max puffs per day (600 puffs). The exposure given to these mice is 4000% that any regular e-cigarette user is exposed to.
The author's claims that this is "relatively low" exposure is false and the exposure does not in any way mimic the exposure an e-cigarette user would be exposed to. Why should we take these results as evidence if harm in humans when real world results is smokers transitioning to e-cigarettes shows amelioration of their cardiovascular symptoms?

Comment: 

... because the mice received "whole body" exposure rather than breathing it in through their mouths like people do.
 
In addition, this evidence is consistent with the other studies, including short term effects of e-cig use on vascular function of people.
 
What the data are showing is that, at least in terms of these vascular effects, e-cigs are about as bad as conventional cigarettes.

Comment: 

Things like caffeine and stress also increase aortic stiffness. Caffeine at least as much as cigarette smoking it appears. But then I suppose a headline like Vaping as dangerous as a cup of coffee is not as sensational.

Comment: 

Not a good comparison

Ever since the 1988 Surgeon General Report identified nicotine as the addictive drug in tobacco products, the tobacco companies have been trying to trivilaize it by making inappropriate comparisons with caffeine.  These efforts were often done without disclosing the industry's involvement.  Here are a few papers that describe these efforts, mostly based on previously secret internal industry documents:

Tobacco industry sociological programs to influence public beliefs about smoking. Landman A, Cortese DK, Glantz S. Soc Sci Med. 2008 Feb;66(4):970-81. doi: 10.1016/j.socscimed.2007.11.007

Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents. Elias J, Hendlin YH, Ling PM. PLoS Med. 2018 May 1;15(5):e1002562. doi: 10.1371/journal.pmed.1002562. eCollection 2018 May.

Tobacco company strategies to identify and promote the benefits of nicotine. Ling PM, Glantz SA. Tob Control. 2018 Aug 9. pii: tobaccocontrol-2018-054300. doi: 10.1136/tobaccocontrol-2018-054300. [Epub ahead of print]

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