Physicians' Academy for Cardiovascular Education

Unfavourable effect of electronic cigarette smoking similar to tobacco smoking

Vlachopoulos C et al. JACC 2016

Electronic Cigarette Smoking Increases Aortic Stiffness and Blood Pressure in Young Smokers

Vlachopoulos C, Ioakeimidis N., Abdelrasoul M, et al.
JACC. Volume 67(23): 2802–2803. doi:10.1016/j.jacc.2016.03.569


Electronic cigarettes (EC) have been advocated as a less harmful alternative to tobacco cigarettes (TC). Smoking TC increases aortic stiffness and blood pressure (BP) [1].
This research letter compared the effects of EC and TC smoking on aortic stiffness and BP. 24 smokers (aged 30+8 years) without other CV risk factors were measured in four separate occasions: 1: TC over 5 min, 2: EC over 5 min, 3: EC for a period of 30 min, and 4: nothing for 60 min. Nicotine delivery rate is lower and slower with EC than with TC. Aortic stiffness was assessed with carotid-femoral pulse-wave velocity (PWV).

Main results

  • Heart rate increased significantly in TC (4.0 beats/min after 5 min, P<0.05) and EC-30 (3.1 beats/min after 30 min) sessions, but not after EC-5 (P=0.57).
  • Systolic BP increased significantly in TC and EC sessions, without a significant difference between the two forms of smoking.
  • PWV increased by 0.44 m/s as compared with baseline, immediately after the end of TC smoking, and remained elevated throughout the measurement period of 60 min.
  • A significant PWV increase by 0.19 m/s was seen after 15 min in response to EC-5. EC-30 smoking elicited a stronger and prolonged PWV increase, with the peak immediately after the end of smoking, by 0.36 m/s.
  • EC-30 yielded a PWV increases similar to that of TC smoking throughout the study period (F=0.268, P=0.615), while EC-5 led to a less potent PWV increase as compared with TC (F=4.425, P=0.005).


These data show that smoking of an electronic cigarette (30 min) induces an unfavourable effect on aortic stiffness and BP, similar to smoking of tobacco cigarettes. The effect of 5 min of EC smoking on aortic stiffness is weaker and delayed as compared to TC.  
Find this letter online at JACC


1. Vlachopoulos C, Kosmopoulou F, Panagiotakos D, et al. Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections. J Am Coll Cardiol 2004;44:1911–7