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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Article Info
Publication History
Published online: December 15, 2020
Accepted:
December 8,
2020
Received:
October 13,
2020
Footnotes
See editorial by Pipe, pages 683–685 of this issue.
See page 697 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
