Comparison of Acute Effects of E-cigarettes With and Without Nicotine and Tobacco Cigarettes on Hemodynamic and Endothelial Parameters: A Systematic Review and Meta-analysis

Introduction

Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently.

Aims

This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC−) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC).

Methods

Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC− and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Results

Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC−. However, EC+ was observed to cause less detrimental effect on SBP (WMD = − 4.72 mmHg, 95% CI [− 6.58, − 2.86], p < 0.01), and HR (WMD = − 3.11 BPM, 95% CI [− 4.54, − 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = − 1.14 mmHg, 95% CI [− 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC− but to a lesser degree as compared to TC.

Conclusion

EC+ shows greater impairment in hemodynamic and endothelial parameters than EC− but less than TC. Additional studies are needed to evaluate prolonged effects of EC use.

Graphical Abstract