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. 2021 May 27;10(5):e29084.
doi: 10.2196/29084.

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

Renee O'Leary  1 , Maria Ahmed Qureshi  2 , Giusy Rita Maria La Rosa  2 , Robin W M Vernooij  2 , Damian Chukwu Odimegwu  2 , Gaetano Bertino  2 , Riccardo Polosa  1
Affiliations

Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

Renee O'Leary et al. JMIR Res Protoc. .

Abstract

Background: Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions.

Objective: We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS.

Methods: These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer.

Results: The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS.

Conclusions: The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research.

Trial registration: PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094.

International registered report identifier (irrid): DERR1-10.2196/29084.

Keywords: ENDS; cardiovascular; e-cigarettes; respiratory; tobacco harm reduction.

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Conflict of interest statement

Conflicts of Interest: RO is supported by a contract with ECLAT, Srl, and ECLAT has received funding from the Foundation for a Smoke-Free World. RO declares no conflicts of interest. MAQ has a grant from the Foundation for a Smoke-Free World, outside the submitted work, for the project Pakistan Tobacco Economics Research and Dissemination. MAQ declares no conflicts of interest. GRMLR, RWMV, DCO, and GB declare no conflicts of interest. RP has received lecture fees and research funding from Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A/S, Sandoz, MSD, Boehringer Ingelheim, Novartis, Duska Therapeutics, and Forest Laboratories. He has served as a consultant for Pfizer, Global Health Alliance for treatment of tobacco dependence, CV Therapeutics, Boehringer Ingelheim, Novartis, Duska Therapeutics (Electronic Cigarette Industry Trade Association, United Kingdom), Arbi Group Srl, and Health Diplomats. He has served on the Medical and Scientific Advisory Board of Cordex Pharma, Inc, CV Therapeutics, Duska Therapeutics Inc, Pfizer, and PharmaCielo. Lecture fees from a number of European electronic cigarette industry and trade associations (including Féderation Interprofessionnelle de la Vape in France and Federazione Italiana Esercenti Svapo Elettronico in Italy) were directly donated to vapor advocacy nonprofit organizations. RP is the founder of the Center for Tobacco Prevention and Treatment at the University of Catania and the Center of Excellence for the Acceleration of Harm Reduction at the same university and has received support from the Foundation for a Smoke-Free World to conduct eight independent investigator-initiated research projects on harm reduction. RP is currently involved in the following pro bono activities: scientific advisor for Lega Italiana Anti Fumo (Italian Anti-Smoking League), Consumer Advocates for Smoke-free Alternatives and the International Network of Nicotine Consumers Organizations, and Chair of the European Technical Committee for standardization on “Requirements and test methods for emissions of electronic cigarettes” (CEN/TC 437; WG4).

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