Switching from cigarettes to e-cigarette alternatives not associated with improvement in cardiovascular outcomes

1. An improvement in cardiovascular disease (CVD) outcomes was found at 3 months and 6 months after smoking cessation, but with no difference in individuals randomized to treatments such as nicotine-containing e-cigarettes, nicotine-free e-cigarettes, and nicotine replacement therapy (NRT).

Evidence Rating Level: 1 (Excellent)

Smoking is a leading risk factor for numerous health conditions, including lung cancer and cardiovascular disease (CVD). Although nicotine replacement therapy (NRT) and behavioural encouragement are most effective in smoking cessation, high relapse rates demonstrate the need for alternative cessation strategies. For instance, e-cigarettes and vaping products are used by 27% of smokers interested in stopping, in contrast to the 18% who use NRT. However, there is limited evidence on the effects of e-cigarettes on cardiovascular health. Therefore, this randomized controlled trial aimed to compare CVD outcomes at 3 months and 6 months follow-up, for smokers randomized to being treated with nicotine-containing e-cigarettes, nicotine-free e-cigarettes, or NRT. The study population consisted of 248 individuals who smoked more than 10 cigarettes daily, and were wanting to stop smoking. The CVD outcomes measured include flow-mediated dilation (%FMD), mean arterial pressure (MAP), and peak cutaneous vascular conductance (CVCmax) responses to acetyolcholine (ACh) and sodium nitroprusside (SNP). The results showed that %FMD was improved in all 3 groups, at 3 months (β=3.33, 95% CI 2.61-4.05, p = 0.0001) and at 6 months (β=2.69, 95% CI 2.02-3.35, p < 0.0001). There were also no significant differences amongst the 3 treatment groups for other CVD outcomes, such as the CVCmax response to ACh and SNP, and MAP. Overall, this study found an improvement in CVD outcomes 3 and 6 months following smoking cessation, but that this improvement did not vary significantly between treatment groups.

Click to read the study in BMC Medicine

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