Cardiovascular and Pulmonary Responses to Acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-term Users

Matthew C. Tattersall, DO, MS

In this video, Matthew C. Tattersall, DO, MS, provides an overview of the study “Cardiovascular and Pulmonary Responses to Acute Use of Electronic Nicotine Delivery Systems and Combustible Cigarettes in Long-term Users,” including the effects of vaping on blood pressure, heart rate, heart rate variability, vasoconstriction, exercise tolerance, and airflow obstruction.

Additional Resource:

Tattersall MC, Hughey CM, Piasecki TM, et al. Cardiovascular and pulmonary responses to acute use of electronic nicotine delivery systems and combustible cigarettes in long-term users. Chest. 2023:S0012-3692(23)00494-4. doi:10.1016/j.chest.2023.03.047

Matthew C. Tattersall

Matthew C. Tattersall, DO, MS, is an assistant professor of medicine in the Division of Cardiovascular Medicine in the Department of Medicine at the University of Wisconsin hospitals and clinics (Madison, WI).



Matthew C. Tattersall, DO, MS: My name is Dr Matthew Tattersall. I am an assistant professor of medicine at the University of Wisconsin of Madison, and I'm a general cardiologist and a preventive cardiologist. I'm the associate director of the preventive cardiology program here.

Consultant360: Please provide an overview of this study.

Dr Tattersall: Well, so to give a little bit of background with this study is that the use of electronic nicotine delivery systems or ENDS, another term for this would be vaping, is rapidly increasing in the United States, and it is especially prevalent among youth and young adults, with over 20% of high school aged teenagers reporting active vaping. In addition, contemporary ENDS devices use more powerful battery systems and they heat this E-liquid to much higher temperatures, which may increase the delivery of both nicotine and other toxins. So, given the rise in the use of these devices among youth and young adults, in the long, latent periods of both cardiovascular and pulmonary disease, it is vital to uncover some of the potential deleterious cardiopulmonary effects of vaping.

So, our study really evaluated the acute cardiovascular, pulmonary, and exercise stress test response following a nicotine-containing product challenge. So, the cardiac and lung e-cigarette smoking study, or CLUES, the name of the study, was an acute product challenge study that enrolled 114 non-smoking, non-vaping controls, 164 exclusive vapers, and 117 exclusive combustible cigarette users. And cardiopulmonary measures were obtained prior to and following 15 minutes of the product challenge, where participants used their personal devices to replicate a real-world setting.

C360: What were the results and how do they impact clinical practice? 

Dr Tattersall: So, after a single-use session compared to controls, vaping participants had acute increases in both systolic and diastolic blood pressures, increased heart rate, and worsened heart rate variability. There was more brachial artery constriction and worse pulmonary measures such as FEV1. The cardiopulmonary measures among vapers were similar to that of the traditional combustible cigarette users. And in addition, the vapers performed worse on an exercise stress test compared to the controls and similar to the combustible cigarette users. The degree and the magnitude of the worsening of all these cardiopulmonary measures were all clinically significant. And these results really provide clinically relevant data to guide some of the discussions between patients and clinicians on the potential harms of using e-cigarettes or vaping.

C360: What’s next for research on this topic? 

Dr Tattersall: So, there remain so many unanswered questions in this research area. We do not know the contribution of nicotine alone to these cardiopulmonary measures or versus some of the thermal degradation products that arise from superheating these e-liquids to very high temperatures. So, things such as particulate matter and carbonyls and some of these other thermal degradation products could have very significant effects on the vasculature in the pulmonary system.

C360: What are the overall take-home messages from this study?

Dr Tattersall: Yeah, so, the bottom line, following a single nicotine-containing product challenge, the vaping participants had acute and significantly worsened measures of cardiopulmonary measures compared to controls. And these worsened measures approximate that of combustible cigarette users.