Cardiovascular Perspective of the Promises and Perils of E-Cigarettes

The use of tobacco products remains the major preventable cause of cardiovascular disease and mortality. Although much progress has been made in reducing the prevalence of smoking, new opportunities to regulate tobacco products and the recent introduction of e-cigarettes in the market have radically redefined the tobacco landscape. These developments have heightened the need for a more in-depth understanding of the effects of tobacco products on heart disease, and for identifying which components of tobacco products cause cardiovascular damage and which biomarkers and subclinical measures of cardiovascular disease are most reflective of tobacco-induced injury. This understanding is essential not only for developing new regulatory policies, but also for evaluating disease risk that might be associated with the use of new devices such as e-cigarettes. Because the concentration of several harmful and potentially harmful constituents present in cigarette smoke is decreased in e-cigarettes, it has been suggested that the use of e-cigarettes could significantly lessen the burden of cardiovascular disease. E-cigarettes have also been claimed to promote smoking cessation. However, the extent of residual risk associated with carbonyls, particulate matter, nicotine, flavors, and other constituents of e-cigarettes is unclear, and the efficacy of e-cigarettes as cessation devices remains uncertain. Widespread acceptance of these devices could renormalize the use of tobacco products and recruit a new generation of users to nicotine addiction. Therefore, further toxicological, clinical, economic, and marketing research is required to chart a clear, evidence-based pathway for alleviating the cardiovascular disease burden of tobacco products.