New Scientific Statement Highlights Cardiopulmonary Effects of E-Cigarette Use in Teens

E-cigarettes have become increasingly popular among adolescents, and the latest available scientific evidence suggests that using these products has adverse health effects that may worsen over time, leading to an increased risk of diseases. cardiovascular and pulmonary diseases over the course of a person’s life. who use e-cigarettes, according to a new scientific statement from the American Heart Association published today in the Association’s peer-reviewed journal, Dissemination: Research.

A scientific statement is an expert analysis of current research and can inform future clinical practice guidelines. In this statement, “Cardiopulmonary Consequences of Vaping in Adolescents”, experts in basic science, cell and vascular biology, toxicology, pharmacology and epidemiology reviewed evidence-based studies focusing on the cardiopulmonary effects of vaping. e-cigarette use among teens to educate about the short- and long-term risks of vaping and provide advice to reduce teen vaping.

Most studies on e-cigarette use have been conducted in adults or animals. It is critical that we also understand how organ systems are affected in young people who use e-cigarettes, and more specifically, how these effects may persist into adulthood. »

Loren E. Wold, Ph.D., FAHA, Chair of the Scientific Statement Writing Group and Professor and Associate Dean for Research Operations and Compliance at The Ohio State University College of Medicine in Columbus, Ohio

Electronic Nicotine Delivery Systems (ENDS) contain a battery, an atomizer (or heating element) and a reservoir for e-liquid in the form of cartridges, reservoirs or pods. These devices deliver an aerosol (usually containing nicotine or THC, the main psychoactive compound in cannabis) to the user, which is inhaled into the lungs. ENDS were designed to look like pipes, hookahs, cigars, and cigarettes, with e-cigarettes being the most common. Among the latest iterations of e-cigarettes, there are devices that are small and often look like a thumb drive. These devices contain e-liquids with a high nicotine content in the form of salt, combined with other chemicals.

Since e-cigarettes were introduced to the market in the early 2000s, their use has increased dramatically, particularly among teenagers, reversing years of declining youth and young adult smoking rates and declining Nicotine dependence among users of standard fuel-powered cigarettes. In 2019, 27.5% of teens in grades 9-12 and 10.5% of younger teens in grades 6-8 said they had vaped in the past month, according to the National Tobacco Survey among young people in 2019. The Association’s scientific statement notes that although most new e-cigarette users have never smoked combustible cigarettes, teens who start vaping now may become nicotine or tobacco users. for life and it is currently unknown what illnesses may develop over a lifetime of vaping.

According to the statement, the toxicity of e-cigarettes remains poorly understood, in part because most e-cigarette manufacturers have not publicly disclosed full ingredient lists for many e-cigarette products. Since the exact composition of the products in the devices is not known, it is difficult to predict or determine the effects on lung and heart health. Besides nicotine or THC, e-liquids contain vegetable glycerin and propylene glycol, which are on the U.S. Food and Drug Administration (FDA) “generally considered safe” (GRAS) list. However, these compounds were not intended to be inhaled and therefore have not been tested in a way to determine how inhaling them may affect a person. When heated, these compounds often break down into other chemicals such as formaldehyde, which is a known carcinogen.

“Inhaling any foreign substance can have effects on the respiratory and cardiovascular systems,” Wold said. “Additionally, a person’s lung development continues into their early 20s, so teens who vape are at risk of stunted growth or impaired lung development and may not reach their full lung function.”

Previous studies have shown that people who use e-cigarettes are at increased risk for respiratory health problems, including:

• higher rates of wheezing and coughing;
• a greater prevalence of asthma;
• increased susceptibility to pulmonary (lung) infections; and
• increased incidence of respiratory diseases.

Additionally, studies have shown that young adults who use e-cigarettes suffer from stiff blood pressure, impaired blood vessel function, and increased blood pressure and heart rate. This evidence suggests that the acute cardiovascular effects of e-cigarettes may worsen over time with prolonged use, leading to an increased risk of cardiovascular disease in people who use e-cigarettes long-term.

“Although teens who use e-cigarettes do not feel vaping affects them at this time, there is growing evidence that the chemicals in e-cigarette aerosols are harming cardiovascular cells, leading to changes that promote the development of heart disease over time,” Wold said. “It typically takes decades before people who smoke combustible cigarettes develop cardiovascular disease and/or chronic obstructive pulmonary disease, and the same may be true for vaping. A reduction in vaping rates among adolescents may likely help improve long-term cardiopulmonary outcomes among this group.”

The statement’s drafting committee noted that while the cardiopulmonary consequences of vaping are of central interest, vaping is already known to have adverse effects on important elements of health. In particular, the use of electronic cigarettes alters the quality of sleep, potentially affects mental health and leads to addiction by activating certain brain pathways. The use of addictive substances such as nicotine during adolescence can influence addictive behaviors in adulthood. This is of great concern and can lead to lifelong addictions and unhealthy interpersonal behaviors or interactions in social and work settings.

Studies have shown that while some people may find e-cigarettes helpful in quitting combustible cigarettes, many people end up using both products regularly. The editorial board emphasized that it is also important to distinguish between quitting smoking and quitting nicotine. A study from the UK, where the amount of nicotine in e-cigarettes is much lower than in the US, found that e-cigarettes may be more effective than nicotine patches when quitting combustible tobacco (18% vs. 10%, respectively); however, the study found that e-cigarettes were only 20% successful in reducing nicotine consumption, compared to 81% effectiveness for nicotine patches.

“The customization of e-cigarettes, including potency levels, e-liquid content and abundance of flavors, appeals to young people and also makes it difficult to regulate these products,” Wold said. “While the FDA has issued a policy against mint and fruit flavors in e-liquids known to appeal to young people, for certain types of products, menthol flavored products are still available. regulatory standard limiting the concentration of nicotine in e-liquids in the United States Some devices have nicotine levels of 59 mg/mL In comparison, the European Union limits the concentration of nicotine in e-liquids to ≤ 20 mg/mL, which is comparable to the concentration of nicotine in e-liquids. a standard combustible cigarette.”

The statement suggests the following to reduce or prevent youth vaping:

• Remove from the market all flavored electronic cigarettes, including menthol flavored electronic cigarettes;
• Provide more education to young people and their parents regarding the confirmed and potential health risks of e-cigarette use;
• Establish vaping programs for medical students to inform the next generation of medical professionals;
• Provide hospital-based vaping cessation programs for adolescents and adults;
• Regulate the marketing of e-cigarette products on traditional, online and social media platforms popular with young people; and
• Incorporate e-cigarettes into smoke-free air laws.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association Council on Basic Cardiovascular Sciences; the Arteriosclerosis, Thrombosis and Vascular Biology Council; the Hypertension Council; and the Stroke Council. Scientific statements from the American Heart Association promote greater awareness of cardiovascular disease and stroke and help facilitate informed healthcare decisions. Scientific statements describe what is currently known about a subject and areas that require further research. Although scientific statements inform guideline development, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official clinical practice recommendations.