Diabetes and Obesity Center, University of Louisville , Louisville, Kentucky.
Department of Medicine, University of California-San Francisco , San Francisco, California.
Am J Physiol Heart Circ Physiol. 2019 Apr 1;316(4):H801-H827. doi: 10.1152/ajpheart.00591.2018. Epub 2019 Feb 1.
Although substantial evidence shows that smoking is positively and robustly associated with cardiovascular disease (CVD), the CVD risk associated with the use of new and emerging tobacco products, such as electronic cigarettes, hookah, and heat-not-burn products, remains unclear. This uncertainty stems from lack of knowledge on how the use of these products affects cardiovascular health. Cardiovascular injury associated with the use of new tobacco products could be evaluated by measuring changes in biomarkers of cardiovascular harm that are sensitive to the use of combustible cigarettes. Such cardiovascular injury could be indexed at several levels. Preclinical changes contributing to the pathogenesis of disease could be monitored by measuring changes in systemic inflammation and oxidative stress, organ-specific dysfunctions could be gauged by measuring endothelial function (flow-mediated dilation), platelet aggregation, and arterial stiffness, and organ-specific injury could be evaluated by measuring endothelial microparticles and platelet-leukocyte aggregates. Classical risk factors, such as blood pressure, circulating lipoproteins, and insulin resistance, provide robust estimates of risk, and subclinical disease progression could be followed by measuring coronary artery Ca and carotid intima-media thickness. Given that several of these biomarkers are well-established predictors of major cardiovascular events, the association of these biomarkers with the use of new and emerging tobacco products could be indicative of both individual and population-level CVD risk associated with the use of these products. Differential effects of tobacco products (conventional vs. new and emerging products) on different indexes of cardiovascular injury could also provide insights into mechanisms by which they induce cardiovascular harm.
尽管大量证据表明吸烟与心血管疾病（CVD）呈正相关且显著相关，但使用新型和新兴烟草产品（如电子烟、水烟和加热不燃烧产品）与 CVD 风险之间的关系尚不清楚。这种不确定性源于缺乏关于这些产品的使用如何影响心血管健康的知识。可以通过测量对可燃香烟使用敏感的心血管损害生物标志物的变化来评估与新型烟草产品使用相关的心血管损伤。这种心血管损伤可以在几个层面上进行评估。通过测量全身炎症和氧化应激的变化，可以监测有助于疾病发病机制的临床前变化；通过测量内皮功能（血流介导的扩张）、血小板聚集和动脉僵硬，可以衡量特定器官的功能障碍；通过测量内皮细胞微颗粒和血小板白细胞聚集体，可以评估特定器官的损伤。经典的危险因素，如血压、循环脂蛋白和胰岛素抵抗，提供了对风险的可靠估计，通过测量冠状动脉钙和颈动脉内膜中层厚度，可以跟踪亚临床疾病进展。鉴于其中一些生物标志物是主要心血管事件的可靠预测指标，这些生物标志物与新型和新兴烟草产品使用之间的关联可以表明这些产品与个人和人群 CVD 风险相关。烟草产品（传统产品与新型和新兴产品）对不同心血管损伤指标的差异影响也可以深入了解它们引起心血管损害的机制。
