According to 2 independent assessments of the initial study to be presented at the American Heart Association’s Scientific Sessions 2022, grownups who utilized electronic nicotine delivery equipment, or electronic cigarettes, had concerning variations in cardiovascular and blood vessel activity and performed considerably worse on exercise stress testing than individuals who did not utilize any nicotine products. The meeting, which will be conducted in person and electronically in Chicago from November 5-7, 2022, is a major global exchange of the most recent scientific advances, research, and evidence-based clinical practice updates in cardiac science.
The Cardiac and LUng E-cig Smoking (CLUES) Study’s scientists will present two abstracts comparing outcomes among persons who vaped, people who smoked conventional, combustible cigarettes, and the ones who reported not consuming any nicotine products.
Researchers from the University of Wisconsin completed the CLUES study from March 2019 to March 2022. Its goal was to assess the short-term consequences of cigarette smoking and vaping in frequent nicotine addicts to comparable matched peers who did not use nicotine in any manner. Among the 395 survey participants were:
- 164 persons reported utilizing e-cigarettes exclusively for an average of 4.1 years, with 80 percent employing the most current model of vaporizers (mean of 27.4 years, 39 percent female, 86 percent white race);
- 117 persons who smoked conventional, combustible cigarettes consistently for an average of 23 years (mean age of 42.8 years, 44 percent female, 56 percent white race); and
- 114 grownups who revealed never vaping or smoking and who now had negative urine nicotine results (average age 30.8 years, 50 percent female, 69 percent white race).
Researchers examined blood pressure, pulse rate, and the diameter of the arm’s brachial artery, as well as heart rate variability, prior to and up to 15 minutes after participants smoked or vaped in the first report (Abstract SU3138 – Acute Effects Of Nicotine-containing Product Challenges On Cardiovascular And Autonomic Function Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, And Controls: The Clues Study). The research then contrasted the before-and-after readings to those taken 10 to 15 minutes apart in subjects who had never vaped or smoked.
The researchers discovered that, as compared to persons who did not consume nicotine, vapers and those who smoked traditional cigarettes had:
- significant increases in pulse rate, implying that their hearts beat more quickly Those who smoked cigarettes or vaped had an increase in heart rate of about 4 beats per minute (bpm) after smoking or vaping, but those who claimed no nicotine consumption had no variations in heart rate.
- increased systolic (top number) and diastolic (bottom number) blood pressure Blood pressure increased from roughly 122/72 mm Hg to approximately 127/77 mm Hg after vaping or smoking, whereas individuals who never used nicotine products exhibited no variation in blood pressure measurements.
Individuals who utilized nicotine-containing products exhibited increased constriction of blood vessels and worse indicators of variation in heart rate after smoking or vaping, suggesting stimulation of the body’s sympathetic nervous system. The sympathetic nervous system contributes to the activation of the fight-or-flight reflex. When someone is worried or at risk, it gets more active, increasing pulse rate, increasing the heart’s need for oxygen, and causing arterial wall malfunction.
“There were concerning variations in blood pressure, pulse rate, pulse rate variability, as well as blood vessel tone (constriction) immediately after smoking or vaping,” said lead study author Matthew C. Tattersall, D.O., M.S., an assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health and the associate director of preventive cardiology at UW Health in Madison, Wisconsin. “These data reveal greater risk of cardiovascular disease variables soon after smoking or vaping, and sympathetic nervous system stimulation may play a part in the deleterious reactions reported soon after using electronic cigarettes and 90 minutes later following exercise testing.”
The same respondents were contrasted in the case study (Abstract SA3142 – Differences in Treadmill Exercise Stress Testing Parameters Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, And Controls: The Clues Study) to examine their performance in exercise stress testing, which is recognized to forecast cardiovascular disease results. Treadmill stress tests were administered roughly 90 90 minutes after subjects had smoked or vaped, and 90 minutes after those who claimed no nicotine consumption had rested.
During and following the stress test, four outcome measures were gathered and analyzed:
- Metabolic equivalents (METS), is a unit of measurement for exercise capacity or fitness: 1 MET equals sitting silently at rest, while a brisk walk equals 3-4 METS or 3-4 times the energy the body consumes at rest. Lower METS on a stress test are connected with an increased risk of cardiovascular disease.
- The rate-pressure product refers to a measure of the work done by the heart during peak exercise levels, i.e. the workload on the heart. A greater rate indicates that the heart has the ability to work harder.
- Heart rate reserve refers to a measurement of resting heart rate vs maximal projected heart rate during exercise – in other words, how much reserve the heart is able to marshal, with a higher reserve indicating better cardiac fitness.
- The 60-second pulse rate recovery is an indicator of how quickly the pulse rate returns after exercise: the faster the heart rate returns, the better a person’s cardiac condition and long-term cardiovascular prognosis.
People who smoked cigarettes and vaped recorded significantly worst performance on all four activity measures than those who claimed no nicotine use. Furthermore, when contrasted to persons who did not consume nicotine, individuals who vaped or smoked on a daily basis:
- had reduced exercise ability, as evidenced by reduced METS (9.8 for vapers, 9.3 for smokers, and 11.1 for those who were involved in neither).
- when exercising at their greatest capacity, they achieved a decreased heart workload
- had a reduced heart rate reserve, showing poor fitness (87 percent  of the respondents of vapers, 85 percent of smokers, and 91% of those who did neither); and
- After completing the workout test, I noticed a slower recovery of my heart rate (25.2 bpm for vapers, 22.4 for smokers, and 28.1 for individuals who did neither).
“Individuals who vaped evidently performed worse on all four exercise variables compared to those who never used nicotine, even after adjustment for gender, age, and ethnicity/race,” said lead author Christina M. Hughey, M.D., a fellow in cardiovascular medicine at UW Health, the University of Wisconsin-integrated Madison’s health systems. “Although they had vaped for fewer years and were considerably younger, the exercise efficiency of individuals who vaped was not considerably different than that of individuals who used combustible cigarettes.”
“People who vaped obviously performed worse on all four fitness criteria compared to their counterparts who did not use nicotine, even after adjusting for gender, race, and age.” “Our observations from the CLUES research raise questions regarding the possible impacts of chronic use of electronic nicotine delivery systems, notably for heart disease,” said CLUES principal investigator James H. Stein, M.D., FAHA, director of preventive cardiology at UW Health and the Robert Turrell Professor in Cardiovascular Research at the University of Wisconsin School of Medicine and Public Health in Madison. “We did not investigate the long-term implications of vaping, its use as a therapeutic option for smoking, or its efficacy or safety in that setting.” These results, however, are alarming since they suggest that vaping may raise heart disease risk. The recommendation for persons who smoke combustible cigarettes is the same: endeavor to stop using nicotine and tobacco supplies and seek help from your doctor and community to improve your odds of success.”
The CLUES Research was a product challenge experimental research. This implies that people were studied and deliverables were examined prior to and after using nicotine-containing goods, therefore the data cannot demonstrate a cause-and-effect link between the intake of nicotine-containing substances and the cardiac measurements recorded. The researchers could not directly compare the outcomes of smoking to vaping since the smokers who participated in the research were older, and had been using nicotine-containing items for several years (average usage of 23 years for individuals who smoked traditional cigarettes vs. 4 years for those who used electronic cigarette items), and were highly likely to be from minoritized ethnicities and races compared to those who vaped. Because the majority of those who vaped identified as white adults, the findings on the impacts of vaping may not be applicable to individuals of other races and ethnicities.
“These findings contribute to the growing body of research that reveals identical cardiovascular harm among e-cigarette users and combustible cigarette smokers.” Furthermore, it demonstrates that this cardiovascular risk exists even in younger people with a shorter historical record of nicotine usage,” said Aruni Bhatnagar, Ph.D., FAHA, co-director of the American Heart Association’s National Institutes of Health/Food and Drug Administration-funded Tobacco Center of Regulatory Science and a professor of medicine, biochemistry, and molecular biology at the University of Louisville in Louisville, Kentucky. “People should be aware that electronic cigarettes and traditional cigarettes contain addicting nicotine and hazardous substances that can harm their cardiovascular system and overall health.”
