There are several studies in people showing that earlier generations of e-cigarettes inhibit normal blood vessel function as well as studies in animals showing that this is the case for a wide variety of e-cigarettes, including Juul. Now Ziyad Ben Taleb and colleagues have shown that Juul inhibits blood vessel function just like cigarettes do in people. In their new paper, Pod-based e-cigarettes versus combustible cigarettes: The impact on peripheral and cerebral vascular function and subjective experiences, they compare reductions in the ability of blood vessels in the arm to expand in response to increased need for blood flow (known as flow mediated dilation [FMD]) in smokers after they smoke a cigarette or vape a Juul (left panel above). They also showed similar reductions in cerebral blood vessel (blood vessels in the brain), measured as blood flow velocity in the middle cerebral artery (right panel above).
The brain blood flow results are new; no one has reported effects of Juuling on brain blood flow before.
This study adds to the evidence that, at least in terms of vascular disease, e-cigarettes are as bad as smoking. It also draws into question the FDA’s ongoing commitment to supporting the industry’s “continuum of risk” idea. Indeed, FDA has announced a major grant program on how to communicate the continuum of risk. Will that include messages that, at least for some important disease endpoints, the risks of e-cigarettes and cigarettes are similar?
Here is the abstract:
INTRODUCTION The vaping epidemic in the US has been largely attributed to the emergence of pod-based e-cigarette devices. While these devices continue to be promoted as alternatives to cigarettes, their impact on cardiovascular and behavioral outcomes remains incompletely understood. This study assessed the impact of pod-based e-cigarettes on peripheral and cerebral vascular function, along with subjective experiences among adult cigarette smokers.
METHODS In a crossover laboratory design study, a total of 19 (e-cigarette naïve) cigarette smokers (aged 21–43 years) attended two lab sessions. In one session, participants smoked a cigarette and in the other, vaped a pod-based e-cigarette. Participants completed questions assessing subjective experiences. Peripheral macrovascular and microvascular function was assessed via brachial artery FMD and reactive hyperemia, while cerebral vascular function was assessed as the blood velocity response of the middle cerebral artery during hypercapnia. Measurements were taken before and after exposure.
RESULTS Compared with baseline, there was a reduction in peripheral macrovascular function (indexed by FMD), following e-cigarette (pre=9.3±4.3%; post=6.4±4.1%) and cigarette use (pre=10.2±3.7%; post=6.8±3.8%; main effect of time p<0.0001). Cerebral vascular function (indexed by cerebral vasodilatory response during hypercapnia) was also reduced following e-cigarette (pre=53±19%; post=44±15%) and cigarette use (pre=54±21%; post=44±17%; main effect of time p<0.01). The magnitude of reduction in peripheral and cerebral vascular function was similar between conditions (condition × time, p>0.05). Compared with vaping an e-cigarette, participants scored higher for measures of satisfaction, taste, puff liking, and suppression of craving following smoking (p>0.05).
CONCLUSIONS Similar to smoking, vaping a pod-based e-cigarette leads to an impairment in peripheral and cerebral vascular function while providing a reduced subjective experience compared with a cigarette among adult smokers. While these data challenge the notion that e-cigarette use is a safe and satisfactory alternative to cigarette use, large longitudinal studies are needed to assess the long-term impact of pod-based e-cigarette devices on cardiovascular and behavioral outcomes.
The full citation is: Ben Taleb Z, Dabroy D, Akins J, Nelson MD, Kalan ME, Rezk-Hanna M, Brothers RM. Pod-based e-cigarettes versus combustible cigarettes: The impact on peripheral and cerebral vascular function and subjective experiences. Tob Induc Dis. 2023 May 26;21:71. doi: 10.18332/tid/162366. PMID: 37252033; PMCID: PMC10210091. It is available here.
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