Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes
Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes
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DOI：
10.1016/j.jacc.2019.09.067
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发表时间：
2019-12-24
影响因子：
24
通讯作者：
Lang, Chim C.
中科院分区：
文献类型：
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作者：
George, Jacob;Hussain, Muhammad;Lang, Chim C.
背景电子烟(EC)的使用量在全球范围内呈指数级增长。在慢性吸烟者中，从烟草香烟(TC)转向EC的早期心血管影响尚不清楚。血流介导的扩张(FMD)研究的Meta分析表明，FMD每改善1%，心血管事件的合并、调整后的相对风险就降低13%。目的本研究试图确定慢性吸烟者从TC转换为EC的早期血管影响。方法作者进行了一项前瞻性、随机对照试验，吸烟者=18岁，吸烟者=18岁，吸烟者=15支/天，吸烟者=2年，且没有明确的心血管疾病。参与者被随机分为服用尼古丁的EC和不服用尼古丁的EC，为期1个月。那些不愿戒烟的人继续与TC并驾齐驱。进行倾向性评分分析，以调整随机组和偏爱组之间的差异。用FMD和脉搏波速度评价血管功能。结果从TC转换为EC后1个月内，内皮功能有明显改善(线性趋势β=0.73%；95%可信区间：0.41~1.05；P<；0.0001；TC与EC合计：1.49%；95%CI：0.93~2.04；P<；0.0001)和血管硬度(-0.529 m/S；95%CI：-0.946~-0.112；p=0.014)。在每次组间比较中，女性比男性从更换中受益更多。对EC Switch依从性最好的患者进步最大。在研究时间范围内，使用尼古丁的EC和不使用尼古丁的EC之间的血管效应没有差异。结论TC吸烟者，尤其是女性，在从TC转换为EC的1个月内，血管健康状况有显著改善。从TC转换到EC可以被认为是减少危害的措施。(C)2019年提交人。由爱思唯尔公司代表美国心脏病学会基金会出版。
BACKGROUND E-cigarette (EC) use is increasing exponentially worldwide. The early cardiovascular effects of switching from tobacco cigarettes (TC) to EC in chronic smokers is unknown. Meta-analysis of flow-mediated dilation (FMD) studies indicate 13% lower pooled, adjusted relative risks of cardiovascular events with every 1% improvement in FMD.OBJECTIVES This study sought to determine the early vascular impact of switching from TC to EC in chronic smokers.METHODS The authors conducted a prospective, randomized control trial with a parallel nonrandomized preference cohort and blinded endpoint of smokers >= 18 years of age who had smoked >= 15 cigarettes/day for >= 2 years and were free from established cardiovascular disease. Participants were randomized to EC with nicotine or EC without nicotine for 1 month. Those unwilling to quit continued with TC in a parallel preference arm. A propensity score analysis was done to adjust for differences between the randomized and preference arms. Vascular function was assessed by FMD and pulse wave velocity. Compliance with EC was measured by carbon monoxide levels.RESULTS Within 1 month of switching from TC to EC, there was a significant improvement in endothelial function (linear trend beta = 0.73%; 95% confidence interval [CI]: 0.41 to 1.05; p < 0.0001; TC vs. EC combined: 1.49%; 95% CI: 0.93 to 2.04; p < 0.0001) and vascular stiffness (-0.529 m/s; 95% CI: -0.946 to -0.112; p = 0.014). Females benefited from switching more than males did in every between-group comparison. Those who complied best with EC switch demonstrated the largest improvement. There was no difference in vascular effects between EC with and without nicotine within the study timeframe.CONCLUSIONS TC smokers, particularly females, demonstrate significant improvement in vascular health within 1 month of switching from TC to EC. Switching from TC to EC may be considered a harms reduction measure. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.