JUUL™ing and Heating Lead to a Worsening of Arterial Stiffness

Abstract

Background: The widespread use of the JUUL™ device ignited a discussion about the effects these products have on harm reduction. Therefore, we conducted a study directly comparing the JUUL™ device with a cigarette, a heated tobacco product, and a nicotine-free e-cigarette to examine the acute effects on arterial stiffness. Methods: This crossover-designed study examines 20 occasional smokers (age 25.2 ± 2.5 years). Study participants used each of the four smoking devices for a duration of 5 min following a protocol. Peripheral blood pressure and parameters of arterial stiffness and endothelial vasodilator function such as the reactive hyperemia index and the augmentation index were measured using the EndoPAT™2000 before and after. Results: In addition to significant peripheral hemodynamic changes after 5 and 10 min (p < 0.05), the reactive hyperemia index showed a significant decrease for all devices 15 min after consumption and remained significantly decreased after 60 min (p < 0.01). The augmentation index adjusted for a heart rate of 75 bpm increased significantly for all devices 15 and 60 min after consumption (p < 0.01). Conclusions: In conclusion, the increases in blood pressure and arterial stiffness are similar after smoking, JUUL™ing, heating, and vaping. These changes may be associated with an increase in cardiovascular risks; however, an evaluation of the long-term effects of JUUL™ing, vaping and heating is needed.

Keywords: HTP; JUUL; arterial stiffness; cardiovascular risks; cigarette; e-cigarette; endothelial dysfunction; heating; smoking; vaping.

Figure 1

Flowchart of the study design. The minimum period to complete the study for one individual subject amounted 12 days including the screening day, the day for consideration, as well as the hours of each washout period.

Figure 2

Concentration of carbon monoxide in exhaled air before and after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 3

Peripheral systolic blood pressure in a frequency of 5 min until 75 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine. There was a significant increase in the peripheral systolic blood pressure right after the consumption of the cigarette, JUUL™, and heated tobacco product.

Figure 4

Peripheral diastolic blood pressure in a frequency of 5 min until 75 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine. There was a significant increase in the peripheral diastolic blood pressure right after the consumption of the cigarette, JUUL™, and heated tobacco product.

Figure 5

Peripheral pulse pressure in a frequency of 5 min until 75 min after consuming the cigarette, JUUL^TM, heated tobacco product and e-cigarette without nicotine. There were no changes reaching significance after the use of any of the devices.

Figure 6

Heart rate in a frequency of 5 min until 75 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine. There was a significant increase in the heart rate right after the consumption of the cigarette, JUUL™, and heated tobacco product.

Figure 7

Reactive hyperemia index before and 15 as well as 60 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 8

Natural logarithm of the RHI before and 15 as well as 60 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 9

Augmentation index adjusted at a heart rate of 75 bpm before and 15 as well as 60 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 10

Plasma cortisol concentration analyzed before as well as 12 and 120 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 11

Leucocytes analyzed before, as well as 120 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 12

Immature granulocytes analyzed before as well as 120 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.

Figure 13

Neutrophil granulocytes analyzed before as well as 120 min after consuming the cigarette, JUUL^TM, heated tobacco product, and e-cigarette without nicotine.