Kundu Anasua, Feore Anna, Sanchez Sherald, Abu-Zarour Nada, Sutton Megan, Sachdeva Kyran, Seth Siddharth, Schwartz Robert, Chaiton Michael
University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
University College Cork, Cork, Ireland.
Heart. 2025 Feb 26. doi: 10.1136/heartjnl-2024-325030.
There is substantial interest in the cardiovascular effects of e-cigarette use, highlighting the need to update our knowledge on the subject. We conducted this review to analyse whether e-cigarette use increases cardiovascular health risks and how these risks vary among different populations.
We searched six databases and included peer-reviewed human, animal, cell/in vitro original studies but excluded qualitative studies, which were published between July 2021 and December 2023. Three types of e-cigarette exposure were examined: acute, short-to-medium term and long term. Different risk of bias tools were used for assessing the quality of the included human studies and we conducted meta-analysis when possible.
We included 63 studies in the main analysis, 12 studies in the meta-analysis and 32 studies in the sociodemographic factor-based subgroup analysis. Over half of the human studies had low risk of bias. Acute exposure to e-cigarette was associated with increased heart rate (HR) (mean difference (MD) 11.329, p<0.01) and blood pressure (BP) (MD 12.856, p<0.01 for systolic; MD 7.676, p<0.01 for diastolic) compared with non-use. While HR was lower after acute exposure to e-cigarettes compared with cigarettes (MD -5.415, p<0.01), no significant difference in systolic or diastolic BP was observed. Non-smoker current vapers had no significant differences in resting HR and BP compared with non-users but lower resting HR (MD -2.608, p<0.01) and diastolic BP (MD -3.226, p<0.01) compared with non-vaper current smokers. Despite some association between e-cigarette and endothelial dysfunction, short-to-medium-term transition from cigarettes to e-cigarettes may improve blood flow and BP, particularly among females and younger individuals. There is lack of evidence supporting any association of e-cigarette use with cardiovascular diseases and cardiac dysfunction or remodelling.
This review highlighted several important cardiovascular impacts of e-cigarette use compared with non-use and cigarette smoking. However, the evidence is still limited and requires future research.
CRD42023385632.
电子烟使用对心血管系统的影响备受关注，这凸显了更新我们在该主题上知识的必要性。我们开展本综述以分析使用电子烟是否会增加心血管健康风险，以及这些风险在不同人群中如何变化。
我们检索了六个数据库，纳入了经同行评审的人类、动物、细胞/体外原始研究，但排除了定性研究，研究发表时间为2021年7月至2023年12月。研究了三种类型的电子烟暴露：急性、短期至中期和长期。使用不同的偏倚风险工具评估纳入的人类研究的质量，并在可能的情况下进行荟萃分析。
我们在主要分析中纳入了63项研究，在荟萃分析中纳入了12项研究，在基于社会人口学因素的亚组分析中纳入了32项研究。超过一半的人类研究偏倚风险较低。与不使用电子烟相比，急性暴露于电子烟与心率（HR）升高（平均差（MD）11.329，p<0.01）和血压（BP）升高（收缩压MD 12.856，p<0.01；舒张压MD 7.676，p<0.01）相关。虽然与吸烟相比，急性暴露于电子烟后心率较低（MD -5.415，p<0.01），但未观察到收缩压或舒张压有显著差异。当前使用电子烟的非吸烟者与不使用者相比，静息心率和血压无显著差异，但与当前不使用电子烟的吸烟者相比，静息心率较低（MD -2.608，p<0.01），舒张压较低（MD -3.226，p<0.01）。尽管电子烟与内皮功能障碍之间存在一些关联，但从香烟短期至中期过渡到电子烟可能会改善血流和血压，尤其是在女性和年轻人中。缺乏证据支持使用电子烟与心血管疾病、心脏功能障碍或重塑之间存在任何关联。
本综述强调了与不使用电子烟和吸烟相比，使用电子烟对心血管系统有几个重要影响。然而，证据仍然有限，需要未来进一步研究。
PROSPERO注册号：CRD42023385632。
