Comparable impairment of vascular endothelial function by a wide range of electronic nicotine delivery devices

Introduction  Electronic nicotine delivery systems (ENDS; i.e., vaping devices) such as e-cigarettes, heated tobacco products, and newer coil-less ultrasonic vaping devices are promoted as less harmful alternatives to combustible cigarettes. However, their cardiovascular effects are understudied. We investigated whether exposure to aerosol from a wide range of ENDS devices, including a new ultrasonic vaping device, impairs endothelial function.

Methods  We measured arterial flow-mediated dilation (FMD) in rats (n=8/group) exposed to single session of 10 cycles of pulsatile 5s exposure over 5 minutes to aerosol from e-liquids with and without nicotine generated from a USONICIG ultrasonic vaping device, previous generation e-cigarettes, 5% nicotine JUUL pods (Virginia Tobacco, Mango, Menthol), and an IQOS heated tobacco product; with Marlboro Red cigarette smoke and clean air as controls.  We evaluated nicotine absorption and serum nitric oxide levels after exposure, and effects of different nicotine acidifiers on platelet aggregation.

Results  Aerosol/smoke from all conditions except air significantly impaired FMD. Serum nicotine varied widely from highest in the IQOS group to lowest in USONICIG and previous generation e-cig groups. NO levels were not affected by exposure. Exposure to JUUL and similarly acidified nicotine salt e-liquids did not affect platelet aggregation rate. Despite lack of heating coil, the USONICIG under airflow conditions heated e-liquid to ~77˚C.  

Conclusions  A wide range of ENDS, including multiple types of e-cigarettes with and without nicotine, a heated tobacco product, and an ultrasonic vaping device devoid of heating coil, all impair FMD after a single vaping session comparably to combusted cigarettes.

引言 电子尼古丁传送系统（Electronic Nicotine Delivery Systems, ENDS；即雾化设备），例如电子烟、加热烟草制品以及新型无线圈超声雾化设备，均被宣传为相较于可燃卷烟危害更低的替代品。然而其心血管效应尚未得到充分研究。本研究旨在探究暴露于多款ENDS设备（包括一款新型超声雾化设备）所产生的气溶胶是否会损伤内皮功能。

方法 本研究对每组8只大鼠开展实验：使其单次暴露于10个循环的脉动式气溶胶/烟雾中，每次暴露5秒，总时长5分钟。气溶胶/烟雾来源包括：由USONICIG超声雾化设备产生的含尼古丁与不含尼古丁的电子烟液、前代电子烟、5%尼古丁JUUL烟弹（弗吉尼亚烟草、芒果、薄荷醇口味）、IQOS加热烟草制品；同时设置万宝路红卷烟烟雾与清洁空气作为对照。本研究检测了暴露后的尼古丁吸收情况、血清一氧化氮（nitric oxide, NO）水平，并评估了不同尼古丁酸化剂对血小板聚集的影响。

结果 除清洁空气组外，所有条件下的气溶胶/烟雾均显著损伤了血流介导的血管舒张（Flow-mediated dilation, FMD）功能。血清尼古丁水平差异显著：IQOS组最高，USONICIG组与前代电子烟组最低。一氧化氮水平未受暴露影响。暴露于JUUL及同款酸化尼古丁盐电子烟液不会改变血小板聚集速率。尽管无加热线圈，USONICIG设备在气流条件下可将电子烟液加热至约77℃。

结论 多款ENDS设备，包括多款含/不含尼古丁的电子烟、一款加热烟草制品以及一款无加热线圈的超声雾化设备，在单次雾化暴露后均会以与可燃卷烟相当的程度损伤血流介导的血管舒张功能。