Physicians' Academy for Cardiovascular Education

E-cigarette use may not be harmless

Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users Implications for Cardiovascular Risk

Literature - Moheimani RS, Bhetraratana M, Yin F, et al. - JAMA Cardiol. 2017; published online ahead of print


Electronic (e)-cigarettes contain nicotine, flavourings and a moisturising substance instead of tobacco, they are seen as a safer alternative to tobacco cigarettes and are very popular [1-5]. However, there are no data about the impact of their use on the cardiovascular (CV) system or on the mechanisms by which tobacco cigarettes increase CV risk.

In this study, the effects of e-cigarettes use on heart rate (HR) variability, systemic oxidative stress, and inflammation were evaluated in e-cigarette smokers and compared with non-smokers.

Main results


In a small cross-sectional study, habitual e-cigarette use was associated with a shift in cardiac autonomic balance toward sympathetic predominance and increased oxidative stress, both indicative of increased CV risk. These data suggest that habitual e-cigarette use is associated with physiologic effects and that e-cigarette use is not harmless.

Editorial comment

In his editorial article [6], Bhatnagar briefly discusses the e-cigarette debate. Subsequently, he shares some interesting comments regarding the endpoints used in the study of Moheimani et al, suggesting that they may not reflect accurately the extend of increased CVD risk. The author concludes: ‘How e-cigarettes can induce oxidative stress in the absence of tar and other long-lived radicals remains unclear, and further studies are required not only to fully explore the reasons for the interesting observations of Moheimani et al but also to assess in greater depth the CV effects of e-cigarettes. Such investigations are critical for evaluating how harmful e-cigarettes are and whether their widespread acceptance will decrease the incidence of CVD or, by renormalizing smoking and promoting nicotine addiction, erode public health gains made by evidence-based tobacco control and regulation.’


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Find this article online at JAMA cardiol

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