Acute Cardiovascular Changes Similar in Chronic Vapers and Chronic Smokers

There are similar cardiovascular outcomes in patients that vape chronically and patients that smoke chronically.

Acute increases in blood pressure (BP), heart rate (HR), and vasoconstriction, and reductions in time domain HR variability after use of an electronic nicotine delivery device were found in individuals with chronic vaping. These acute changes were similar to values measured in individuals with chronic cigarette smoking. These study findings were presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5th through 7th, in Chicago, Illinois.

Researchers sought to characterize the cardiovascular effects of electronic nicotine delivery devices. Chronic electronic nicotine delivery device users (vapers) and patients with chronic use of combustible cigarettes (smokers) were hypothesized to have differences in acute cardiovascular and autonomic function responses compared with nonvaping/nonsmoking individuals (control patients).

The researchers conducted the cross-sectional CLUES study that included 395 individuals, of whom 164 were exclusive vapers (exhaled carbon monoxide [CO] <5ppm, positive urine NicCheck I test), 117 were exclusive smokers (CO >5ppm, positive urine NicCheck), and 114 were nonvaping/nonsmoking control patients (CO <5ppm, negative urine NicCheck).

Before and 15 minutes after product use measurements were taken by the researchers to obtain values for time domain HR variability (root mean square differences in successive normal intervals [RMSSD]; % adjacent normal intervals longer than 50 ms [PNN50]), brachial artery diameter, HR, and systolic and diastolic BP. They used age, sex, and race as covariates in linear mixed models to predict outcome measures from group, time, and group multiplied by time. This was followed by group contrasts via post-hoc t-tests with Bonferroni-corrected P-values.

Chronic vapers showed acute increases in BP and HR, vasoconstriction, and reductions in time domain HR variability after using ENDs, similar to cigarette use by smokers.

Among study individuals, vapers (mean age, 27.4 [SD, 10.6] years; 39% women; 86% White) had vaped for significantly less time (4.1 [SD, 2.7] years) than smokers (mean age, 42.8 [SD, 13.8] years; 44% women; 56% White) had smoked (23.0 [SD, 13.0] years). Control individuals were not matched for age, sex, or race (mean age, 30.8 [SD, 11.9] years; 50% women; 69% White) with either study cohort.

The researchers found that vapers had greater reductions in RMSSD, PNN50, and brachial artery diameter compared with control patients (all P ≤.003). They observed vapers had greater increases in HR, systolic BP, and diastolic BP compared with control patientss (all P ≤.002). All results for vapers were similar to results among smokers.

Study limitations include that the majority of patients in the vaping group are White and there is a significant difference in mean time of smoking vs vaping between groups.

 “Chronic vapers showed acute increases in BP and HR, vasoconstriction, and reductions in time domain HR variability after using ENDs [electronic nicotine delivery devices], similar to cigarette use by smokers,” the researchers wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Tattersall MC, Hughey CM, Piasecki TM, et al. Acute effects of nicotine-containing product challenges on cardiovascular and autonomic function among electronic cigarette vapers, combustible cigarette smokers, and controls: The Clues Study. Presented at: The American Heart Association (AHA) Scientific Sessions 2022; November 5-7, 2022; Chicago, IL. Abstract #SU3138.