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Canadian Journal of Cardiology

Vaping Instead of Cigarette Smoking: A Panacea or Just Another Form of Cardiovascular Risk?

  • Arash Nayeri
    Affiliations
    Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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  • Holly Middlekauff
    Correspondence
    Corresponding author: Dr Holly Middlekauff, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, A2-237 CHS, 650 Charles Young Drive South, Los Angeles, California 90025, USA. Tel.: +1-310-206-6672; fax: +1-310-206-9133.
    Affiliations
    Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    Search for articles by this author
Published:December 15, 2020DOI:https://doi.org/10.1016/j.cjca.2020.12.008

      Abstract

      Since 2007, the electronic cigarette (EC), with its increasingly diverse array of device options, has gained popularity both among long-term tobacco cigarette (TC) smokers and among never-smoking youth. The absence of a number of known toxic by-products of TC smoking has helped cultivate the perception that ECs are healthy. However, an expanding literature has provided concerning evidence that a number of EC constituents, including nicotine, and their thermal degradation by-products may have adverse effects, including cardiovascular effects. In this review, we discuss the cardiovascular risks associated with EC vaping and compare this risk profile with TC smoking. Acknowledging the dynamic nature of EC vaping, we will focus on the latest developments, including the introduction of the pod-like device, which is the most popular EC device used today. We discuss the implications of a new, unique, nicotine chemistry that mimics the efficient and addictive nicotine delivery of TCs. Furthermore, we touch on the outbreak of the lethal lung disease associated with ECs, which exposed the lack of quality control in the EC industry. Along the way, we will identify the limitations of current knowledge and provide suggestions for future research. Overall, we conclude that although ECs may once have held promise as part of a harm-reduction strategy in people who smoke lethal TCs, this role has been largely offset by the unconscionable marketing to our youth, in addition to a failure of regulation and enforcement, leading to significant harm, especially in never-smokers who use them.

      Résumé

      Depuis 2007, la cigarette électronique (CE), qui s’accompagne de plus en plus d’options, a gagné en popularité tant chez les fumeurs de cigarettes au tabac (CT) de longue date que chez les jeunes qui n’ont jamais fumé. L’absence de certains sous-produits toxiques liés à la consommation de CT a contribué à alimenter la perception que la CE est sans danger. Cependant, de plus en plus de publications font état de données préoccupantes quant au fait que certains constituants des CE, y compris la nicotine, et leurs sous-produits de dégradation thermique pourraient avoir des effets indésirables, notamment des effets cardiovasculaires. Nous présentons ici les risques cardiovasculaires associés au vapotage et comparons les profils de risque de la CE et de la CT. Compte tenu de l’évolution dynamique de la CE, nous nous concentrons sur les nouveautés les plus récentes, notamment les dispositifs à capsule, l’un des types de CE les plus populaires de l’heure. Nous discutons des répercussions d’une nouvelle chimie de la nicotine unique qui reproduit l’inhalation efficace de la nicotine créant la dépendance à la CT. Nous traitons également de la flambée de troubles pulmonaires mortels associés à la CE, qui a révélé l’absence du contrôle de la qualité dans l’industrie du vapotage. En cours de route, nous cernons les lacunes des connaissances actuelles et formulons des suggestions pour de futures études. Dans l’ensemble, nous arrivons à la conclusion que même si on a autrefois cru que la CE pourrait jouer un rôle dans le cadre d’une stratégie de réduction des méfaits mortels de la CT, ce rôle est considérablement amoindri par les torts importants, en particulier chez les personnes n’ayant jamais fumé qui utilisent la CE, découlant de la publicité sans scrupules faite auprès des jeunes ainsi que de l’inefficacité de la réglementation et de l’application des lois.
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      Linked Article

      • Vaping, Smoking Cessation, and Harm Reduction? Look Before You Leap
        Canadian Journal of CardiologyVol. 37Issue 5
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          Tobacco addiction, arguably the most significant and deadly of the modifiable cardiovascular risk factors—and the most neglected—has long been a challenge for the cardiovascular specialist.1 Notwithstanding the significant reduction in smoking that has occurred in Canada over the past 50 years—only 14%-16% of Canadians are now smokers—it remains a persistent pathologic feature of the lives of many of our patients. Cardiovascular clinicians have been enjoined to address the challenge of smoking cessation by supporting a systematic approach to the management of their smoking patients with the use of cessation aids and supportive counselling.
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