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Original Research: Tobacco Cessation and Prevention |

Acute Impact of Tobacco vs Electronic Cigarette Smoking on Oxidative Stress and Vascular Function

Roberto Carnevale, PhD; Sebastiano Sciarretta, MD; Francesco Violi, MD; Cristina Nocella, PhD; Lorenzo Loffredo, MD; Ludovica Perri, MD; Mariangela Peruzzi, MD, PhD; Antonino G.M. Marullo, MD, PhD; Elena De Falco, PhD; Isotta Chimenti, PhD; Valentina Valenti, MD; Giuseppe Biondi-Zoccai, MD, MStat; Giacomo Frati, MD
Author and Funding Information

Drs Carnevale and Sciarretta contributed equally to this manuscript.

Drs Frati and Biondi-Zoccai are joint senior authors.

FUNDING/SUPPORT: This work was supported in part by a grant from Sapienza University of Rome (project no. C26H148CRP; 2014) to Dr Frati.

aDepartment of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy

cDepartment of AngioCardioNeurology, IRCCS NeuroMed, Pozzilli, Italy

CORRESPONDENCE TO: Roberto Carnevale, PhD, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):606-612. doi:10.1016/j.chest.2016.04.012
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Background  The vascular safety of electronic cigarettes (e-Cigarettes) must still be clarified. We compared the impact of e-Cigarettes vs traditional tobacco cigarettes on oxidative stress and endothelial function in healthy smokers and nonsmoker adults.

Methods  A crossover, single-blind study was performed in 40 healthy subjects (20 smokers and 20 nonsmokers, matched for age and sex). First, all subjects smoked traditional tobacco cigarettes. One week later, the same subjects smoked an e-Cigarette with the same nominal nicotine content. Blood samples were drawn just before and after smoking, and markers of oxidative stress, nitric oxide bioavailability, and vitamin E levels were measured. Flow-mediated dilation (FMD) was also measured.

Results  Smoking both e-Cigarettes and traditional cigarettes led to a significant increase in the levels of soluble NOX2-derived peptide and 8-iso-prostaglandin F2α and a significant decrease in nitric oxide bioavailability, vitamin E levels, and FMD. Generalized estimating equation analysis confirmed that all markers of oxidative stress and FMD were significantly affected by smoking and showed that the biologic effects of e-Cigarettes vstraditional cigarettes on vitamin E levels (P = .413) and FMD (P = .311) were not statistically different. However, e-Cigarettes seemed to have a lesser impact than traditional cigarettes on levels of soluble NOX2-derived peptide (P = .001), 8-iso-prostaglandin F2α (P = .046), and nitric oxide bioavailability (P = .001).

Conclusions  Our study showed that both cigarettes have unfavorable effects on markers of oxidative stress and FMD after single use, although e-Cigarettes seemed to have a lesser impact. Future studies are warranted to clarify the chronic vascular effects of e-Cigarette smoking.


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