E-Cigarettes and Cardiopulmonary Health

Robert Tarran¹, R Graham Barr², Neal L Benowitz³, Aruni Bhatnagar⁴, Hong W Chu⁵, Pamela Dalton⁶, Claire M Doerschuk⁷, M Bradley Drummond⁷, Diane R Gold⁸, Maciej L Goniewicz⁹, Eric R Gross¹⁰, Nadia N Hansel¹¹, Philip K Hopke¹², Robert A Kloner¹³, Vladimir B Mikheev¹⁴, Evan W Neczypor¹⁵, Kent E Pinkerton¹⁶, Lisa Postow¹⁷, Irfan Rahman¹⁸, Jonathan M Samet¹⁹, Matthias Salathe²⁰, Catherine M Stoney¹⁷, Philip S Tsao²¹, Rachel Widome²², Tian Xia²³, DaLiao Xiao²⁴, Loren E Wold²⁵

Affiliations

¹ Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA.
² Department of Medicine, Columbia University, New York, NY, USA.
³ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Medicine, American Heart Association Tobacco Regulation Center University of Louisville, Louisville, KY, USA.
⁵ Department of Medicine, National Jewish Health, Denver, CO, USA.
⁶ Monell Chemical Senses Center, Philadelphia, PA, USA.
⁷ Department of Medicine, Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA.
⁸ Department of Environmental Health, Harvard T.H. Chan School of Public Health and the Channing Division of Network Medicine, Boston, MA, USA.
⁹ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
¹⁰ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA.
¹¹ Division of Pulmonary & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹² Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
¹³ Huntington Medical Research Institutes, Pasadena, CA, USA.
¹⁴ Individual and Population Health, Battelle Memorial Institute, Columbus, OH, USA.
¹⁵ Biomedical Science Program, College of Medicine, The Ohio State University, Columbus, OH, USA.
¹⁶ Center for Health and the Environment, University of California, Davis, CA, USA.
¹⁷ National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
¹⁸ Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
¹⁹ Colorado School of Public Health, Aurora, CO, USA.
²⁰ Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
²¹ Division of Cardiovascular Medicine, VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA.
²² Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
²³ Department of Medicine, University of California, Los Angeles, CA, USA.
²⁴ Department of Basic Sciences, Lawrence D Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
²⁵ Dorothy M. Davis Heart and Lung Research Institute, Colleges of Medicine and Nursing, The Ohio State University, Columbus, OH, USA.

PMID: 33748758
PMCID: PMC7948134
DOI: 10.1093/function/zqab004

Review

E-Cigarettes and Cardiopulmonary Health

Robert Tarran et al. Function (Oxf). 2021.

. 2021 Feb 8;2(2):zqab004.

doi: 10.1093/function/zqab004. eCollection 2021.

Authors

Affiliations

¹ Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA.
² Department of Medicine, Columbia University, New York, NY, USA.
³ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Medicine, American Heart Association Tobacco Regulation Center University of Louisville, Louisville, KY, USA.
⁵ Department of Medicine, National Jewish Health, Denver, CO, USA.
⁶ Monell Chemical Senses Center, Philadelphia, PA, USA.
⁷ Department of Medicine, Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA.
⁸ Department of Environmental Health, Harvard T.H. Chan School of Public Health and the Channing Division of Network Medicine, Boston, MA, USA.
⁹ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
¹⁰ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA.
¹¹ Division of Pulmonary & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹² Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
¹³ Huntington Medical Research Institutes, Pasadena, CA, USA.
¹⁴ Individual and Population Health, Battelle Memorial Institute, Columbus, OH, USA.
¹⁵ Biomedical Science Program, College of Medicine, The Ohio State University, Columbus, OH, USA.
¹⁶ Center for Health and the Environment, University of California, Davis, CA, USA.
¹⁷ National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
¹⁸ Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
¹⁹ Colorado School of Public Health, Aurora, CO, USA.
²⁰ Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
²¹ Division of Cardiovascular Medicine, VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA.
²² Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
²³ Department of Medicine, University of California, Los Angeles, CA, USA.
²⁴ Department of Basic Sciences, Lawrence D Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
²⁵ Dorothy M. Davis Heart and Lung Research Institute, Colleges of Medicine and Nursing, The Ohio State University, Columbus, OH, USA.

PMID: 33748758
PMCID: PMC7948134
DOI: 10.1093/function/zqab004

Abstract

E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.

Keywords: cardiovascular disease; cessation; e-cigarette; policy; pulmonary disease.

Published by Oxford University Press on behalf of American Physiological Society 2021. This work is written by US Government employees and is in the public domain in the US.

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Figures

**Figure 1.**
The Impact of E-Liquid Constituents on Ca²⁺ Homeostasis, and on Subsequent Cellular Functions. After exposure to e-liquid constituents, cytoplasmic Ca²⁺ can be elevated directly via nicotine binding to ligand-gated ion channels (ie, nAChR) (1); by menthol or nicotine activating TRP channel (2); by aldehyde flavors activating ion channels or other proteins (3); or indirectly via activation of PLC and subsequent IP₃ formation (3). These actions directly affect the lung since they can alter protein phosphorylation (4), gene expression (5), induce cytokine/protease secretion (6) and inhibit the CFTR anion channel (7).

**Figure 2.**
Do PG and VG Affect Cells? A combination of PG and VG have been shown to affect membrane rheology and alter protein diffusion. Moreover, PG/VG-exposed mice develop macrophages with cytoplasmic inclusions and show altered lipid biochemistry.

See this image and copyright information in PMC

References

1. Services USDoHaH. E-cigarette use among youth and young adults: a report of the Surgeon General. 2016. Available at: https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_n.... - PubMed
1. Bals R, Boyd J, Esposito S, et al. Electronic cigarettes: a task force report from the European Respiratory Society. Eur Respir J 2019;53:1801151. - PubMed
1. Ahmad S, Sassano MF, Tarran R. Loose ENDs: electronic nicotine delivery systems and the FDA’s recent enforcement policy. EMJ Respir 2020;8:93–96. - PMC - PubMed
1. Blount BC, Karwowski MP, Shields PG, et al. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med 2019:382:697–705. - PMC - PubMed
1. Barrington-Trimis JL, Urman R, Berhane K, et al. E-cigarettes and future cigarette use. Pediatrics 2016;138:e20160379. - PMC - PubMed

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E-Cigarettes and Cardiopulmonary Health

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E-Cigarettes and Cardiopulmonary Health

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