E-Cigarette Effects ON Markers of Cardiovascular AND Pulmonary Disease Risk

项目总结/摘要 在美国，电子烟的使用正在迅速增加，特别是在年轻人中，这突显了电子烟的重要性。 我们需要提高对健康风险的认识。相关数据可以为政策提供信息，指导公共卫生， 临床干预工作，并告知可能使用或正在使用本产品的个人。 在这份提案中，我们描述的研究将大大提高我们对健康影响的理解 电子烟的使用，将电子烟和传统香烟（“产品”）的急性和长期使用与 验证心血管和肺部疾病的生物标志物。我们将招募4个不同的“使用组”， 受试者（n=440）：电子烟专用者（n=110）、香烟专用者（n=110）、双产品使用者 (who吸烟和电子烟：n=110），从不吸烟者（n=110）。这些组反映了主要决策 个人可以对他们未来的烟草用途：继续吸烟，转向电子烟， 香烟，同时使用香烟和电子烟，或者不使用产品。至关重要的是，吸烟者和卫生保健 提供者对这些选择的健康影响有准确的信息。 产品使用将与经过充分验证的生物标志物相关，这些生物标志物准确且可重现地反映 机制、损伤和与心血管或肺部疾病相关的未来风险。生物标志物将与 （1）实验室中的急性产品使用（暴露挑战），（2）产品使用的终身史，和/或（3） 实时测量参与者日常生活中的产品使用情况。主要的心血管生物标志物是 肱动脉血流介导的扩张（内皮功能的测量）和颈动脉内膜中层厚度， 亚临床动脉损伤和动脉粥样硬化的测量。主要肺部疾病生物标志物将是 通过肺活量测定法获得的肺容量和流速（预测的FEV 1、FVC、FEV 1/FVC）的测量值。我们也 我将进行跑步机运动压力测试（评估有氧健身），心电图（测量心脏 心率及其变异性），并测量血压、血脂、HbA 1c和炎症/氧化标志物 （白细胞计数，C-反应蛋白，尿F2异前列腺素）和呼出的一氧化氮。我们将展示如何 产品使用组对（1）急性产品使用和（2）长期使用的心血管反应不同 和肺部生物标志物。我们还将确定产品使用史与生物标志物状态的关系。 拟议的研究将产生有关产品使用、亚临床动脉 损伤、动脉粥样硬化负荷、动脉和肺功能、心脏和有氧适应性、心脏自主神经 失调，全身和肺部炎症，氧化应激，以及其他关键结果。 这些数据将作为未来电子烟健康影响的纵向调查的基础，并将提供信息。 公共政策决策，临床干预和关于电子烟的患者指导。

Project Summary/Abstract E-cigarette use is increasing rapidly in the United States, especially amongst youth, underscoring the vital need to improve understanding of its health risks. Relevant data could inform policy, guide public health and clinical intervention efforts, and inform individuals who might use or who are using this product. In this proposal, we describe research that will significantly enhance our understanding of the health effects of E-cig use by relating the acute and long-term use of E-cigs and conventional cigarettes (“products”) to well- validated cardiovascular and pulmonary disease biomarkers. We will enroll 4 different “use-groups” of participants (n=440): exclusive E-cig users (n=110), exclusive cigarette smokers (n=110), dual product users (who both smoke and vape: n=110), and never smokers (n=110). These groups reflect the primary decisions that individuals can make regarding their future tobacco use: to continue to smoke cigarettes, to switch to E- cigs, to use both cigarettes and E-cigs, or to not use products. It is essential that smokers and health care providers have accurate information on the health effect of these choices. Product use will be related to well-validated biomarkers that accurately and reproducibly reflect mechanisms, injury, and future risks related to cardiovascular or pulmonary disease. Biomarkers will be related to (1) acute product use in the laboratory (exposure challenges), (2) lifetime history of product use, and/or (3) real-time measures of product use in participants' daily lives. The primary cardiovascular biomarkers are brachial artery flow-mediated dilation (a measure of endothelial function) and carotid intima-media thickness, a measure of subclinical arterial injury and atherosclerosis. The primary pulmonary disease biomarkers will be measures of lung volumes and flow rates (predicted FEV1, FVC, FEV1/FVC) obtained by spirometry. We also will perform treadmill exercise stress testing (to assess aerobic fitness), electrocardiography (to measure heart rate and its variability) and measure blood pressure, lipids, HgbA1c, and inflammation/oxidation markers (leukocyte count, C-reactive protein, urinary F2 isoprostanes) and exhaled nitric oxide. We will show how product use-groups differ in response to (1) acute product use and (2) long-term use regarding cardiovascular and pulmonary biomarkers. We also will determine how history of product use is related to biomarker status. The proposed research will yield vital and comprehensive data regarding product use, subclinical arterial injury, atherosclerosis burden, arterial and pulmonary function, cardiac and aerobic fitness, cardiac autonomic dysregulation, systemic and pulmonary inflammation, and oxidative stress, as well as other key outcomes. These data will serve as a foundation for future longitudinal investigations of E-cig health effects and will inform public policy decisions, clinical interventions, and patient guidance regarding E-cigarettes.