Vaping has been marketed as a safe alternative to tobacco cigarettes. However, a single e-cigarette can be harmful to the body’s blood vessels – even when the vapour is entirely nicotine-free – according to a study by researchers in the Perelman School of Medicine at the University of Pennsylvania, published in the journal Radiology.
To study the short-term impacts of vaping, researchers at the University of Pennsylvania School of Medicine performed MRI exams on 31 healthy, non-smoking adults before and after vaping a nicotine-free e-cigarette. Comparing the pre- and post-MRI data, the single episode of vaping resulted in reduced blood flow and impaired endothelial function in the large (femoral) artery that supplies blood to the thigh and leg. The endothelium, which lines the inside surface of blood vessels, is essential to proper blood circulation. Once the endothelium is damaged, arteries thicken and blood flow to the heart and the brain can be cut off, resulting in heart attack or stroke.
“While e-cigarette liquid may be relatively harmless, the vaporisation process can transform the molecules – primarily propylene glycol and glycerol – into toxic substances,” said the study’s principal investigator Dr Felix W Wehrli, a professor of radiologic science and biophysics. “Beyond the harmful effects of nicotine, we’ve shown that vaping has a sudden, immediate effect on the body’s vascular function, and could potentially lead to long-term harmful consequences.”
E-cigarettes are battery-operated devices that convert liquid into aerosol, which is inhaled into the user’s lungs. Typically, the liquid contains addictive nicotine, as well as flavours. More than 10m adults in the US use e-cigarettes, and vaping has become especially popular among teenagers. While there appears to be some consensus that vaping may be less harmful to health than tobacco cigarette smoking, the dangers of e-cigarettes remain unclear.
In this study, the researchers examined the impact of an e-cigarette that contained propylene glycol and glycerol with tobacco flavouring, but no nicotine, which study participants took 16, three-second puffs from. To evaluate vascular reactivity, the group constricted the vessels of the thigh with a cuff and then measured how quickly the blood flowed after its release. Using a multi-parametric MRI procedure, researchers scanned the femoral artery and vein in the leg before and after each vaping episode to see how vascular function changed.
The researchers then performed a statistical analysis to determine group differences in vascular function before and after vaping. They observed, on average, a 34% reduction in the femoral artery’s dilation. E-cigarettes exposure also led to a 17.5% reduction in peak blood flow, a 20% reduction in venous oxygen, and a 25.8% reduction in blood acceleration after the cuff release – the speed at which the blood returned to the normal flow after being constricted.
These findings suggest that vaping can cause significant changes to the inner lining of blood vessels, said study lead author Dr Alessandra Caporale, a post-doctoral researcher in the Laboratory for Structural, Physiologic, and Functional Imaging at Penn. “E-cigarettes are advertised as not harmful, and many e-cigarette users are convinced that they are just inhaling water vapour,” Caporale said. “But the solvents, flavourings and additives in the liquid base, after vapourisation, expose users to multiple insults to the respiratory tract and blood vessels.”
Wehrli noted that they observed these striking changes after the participants (all of whom never smoked previously) used an e-cigarette a single time. More research is needed to address the potential long-term adverse effects of vaping on vascular health, but he predicts that e-cigarettes are potentially much more hazardous than previously assumed. Earlier this year, for instance, his research group found that acute exposure to e-cigarettes causes vascular inflammation.
“I would warn young people to not even get started using e-cigarettes. The common belief is that the nicotine is what is toxic, but we have found that dangers exist, independent of nicotine,” Wehrli said. “Clearly if there is an effect after a single use of an e-cigarette, then you can imagine what kind of permanent damage could be caused after vaping regularly over years.”
Acute effects of electronic cigarette aerosol inhalation on vascular function detected at quantitative MRI
Background: Previous studies showed that nicotinized electronic cigarettes (hereafter, e-cigarettes) elicit systemic oxidative stress and inflammation. However, the effect of the aerosol alone on endothelial function is not fully understood.
Purpose: To quantify surrogate markers of endothelial function in nonsmokers after inhalation of aerosol from nicotine-free e-cigarettes.
Materials and Methods: In this prospective study (from May to September 2018), nonsmokers underwent 3.0-T MRI before and after inhaling nicotine-free e-cigarette aerosol. Peripheral vascular reactivity to cuff-induced ischemia was quantified by temporally resolving blood flow velocity and oxygenation (SvO2) in superficial femoral artery and vein, respectively, along with artery luminal flow-mediated dilation. Precuff occlusion, resistivity index, baseline blood flow velocity, and SvO2 were evaluated. During reactive hyperemia, blood flow velocity yielded peak velocity, time to peak, and acceleration rate (hyperemic index); SvO2 yielded washout time of oxygen-depleted blood, rate of resaturation, and maximum SvO2 increase (overshoot). Cerebrovascular reactivity was assessed in the superior sagittal sinus, evaluating the breath-hold index. Central arterial stiffness was measured via aortic pulse wave velocity. Differences before versus after e-cigarette vaping were tested with Hotelling T2 test.
Results: Thirty-one healthy never-smokers (mean age, 24.3 years ± 4.3; 14 women) were evaluated. After e-cigarette vaping, resistivity index was higher (0.03 of 1.30 [2.3%]; P < .05), luminal flow-mediated dilation severely blunted (−3.2% of 9.4% [−34%]; P < .001), along with reduced peak velocity (−9.9 of 56.6 cm/sec [−17.5%]; P < .001), hyperemic index (−3.9 of 15.1 cm/sec2 [−25.8%]; P < .001), and delayed time to peak (2.1 of 7.1 sec [29.6%]; P = .005); baseline SvO2 was lower (−13 of 65 %HbO2 [−20%]; P < .001) and overshoot higher (10 of 19 %HbO2 [52.6%]; P < .001); and aortic pulse wave velocity marginally increased (0.19 of 6.05 m/sec [3%]; P= .05). Remaining parameters did not change after aerosol inhalation.
Conclusion: Inhaling nicotine-free electronic cigarette aerosol transiently impacted endothelial function in healthy nonsmokers. Further studies are needed to address the potentially adverse long-term effects on vascular health.
Alessandra Caporale, Michael C Langham, Wensheng Guo, Alyssa Johncola, Shampa Chatterjee, Felix W Wehrli