Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, Departments of Medicine and Biopharmaceutical Sciences, University of California, 1001 Potrero Avenue #3316, San Francisco, California 94110, USA.
Center for Tobacco Control Research and Education, University of California, 530 Parnassus Avenue, San Francisco, California 94117, USA.
Nat Rev Cardiol. 2017 Aug;14(8):447-456. doi: 10.1038/nrcardio.2017.36. Epub 2017 Mar 23.
Cardiovascular safety is an important consideration in the debate on the benefits versus the risks of electronic cigarette (EC) use. EC emissions that might have adverse effects on cardiovascular health include nicotine, oxidants, aldehydes, particulates, and flavourants. To date, most of the cardiovascular effects of ECs demonstrated in humans are consistent with the known effects of nicotine. Pharmacological and toxicological studies support the biological plausibility that nicotine contributes to acute cardiovascular events and accelerated atherogenesis. However, epidemiological studies assessing Swedish smokeless tobacco, which exposes users to nicotine without combustion products, generally have not found an increased risk of myocardial infarction or stroke among users, but suggest that nicotine might contribute to acute cardiovascular events, especially in those with underlying coronary heart disease. The effects of aldehydes, particulates, and flavourants derived from ECs on cardiovascular health have not been determined. Although ECs might pose some cardiovascular risk to users, particularly those with existing cardiovascular disease, the risk is thought to be less than that of cigarette smoking based on qualitative and quantitative comparisons of EC aerosol versus cigarette smoke constituents. The adoption of ECs rather than cigarette smoking might, therefore, result in an overall benefit for public health.
心血管安全性是电子烟（EC）使用的益处与风险权衡辩论中的一个重要考虑因素。可能对心血管健康产生不利影响的 EC 排放物包括尼古丁、氧化剂、醛类、颗粒物和香料。迄今为止，在人类中观察到的 EC 的大多数心血管效应与尼古丁的已知效应一致。药理学和毒理学研究支持这样一种生物学可能性，即尼古丁导致急性心血管事件和加速动脉粥样硬化形成。然而，评估瑞典无烟火药的流行病学研究发现，使用者患心肌梗死或中风的风险没有增加，无烟火药使使用者接触尼古丁而不产生燃烧产物，但提示尼古丁可能导致急性心血管事件，尤其是在那些有潜在冠心病的人群中。EC 衍生的醛类、颗粒物和香料对心血管健康的影响尚未确定。尽管 EC 可能对使用者存在一些心血管风险，特别是对那些已经患有心血管疾病的人，但基于 EC 气溶胶与香烟烟雾成分的定性和定量比较，EC 对心血管疾病的风险被认为低于吸烟。因此，采用 EC 而不是吸烟可能会对公众健康带来整体益处。
