Acute Effects of Electronic Cigarettes and Heated Tobacco Products on Vascular Stiffness: A Systematic Review and Meta-Analysis
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Updated: Sep 6, 2026
Comparing the Effects of Electronic Cigarette Vapor and Cigarette Smoke in a Novel In Vivo Exposure System
Published on: May 24, 2017
Anna Bragina1,2, Natalia Druzhinina1,2, Yulia Rodionova1,2
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Introduction:
Cardiovascular diseases remain the leading cause of mortality worldwide. Emerging risk factors, such as electronic cigarettes and Heated Tobacco Products (HTPs), may contribute to vascular damage. This systematic review and meta-analysis aimed to evaluate the association between nicotine-containing electronic cigarettes and HTPs and arterial stiffness.
Methods:
The study followed PRISMA and Cochrane Collaboration guidelines and was registered in the PROSPERO database (ID: CRD42023446895). PubMed, Scopus, Google Scholar, and eLIBRARY databases from January 1, 2000 to July 30, 2024. Outcomes included Pulse Wave Velocity (PWV), Augmentation Index (AIx), Cardio-Ankle Vascular Index (CAVI), ankle- brachial index (ABI).
Results:
From 3,705 abstracts, 9 experimental studies (n=190) were included. CAVI and ABI indices were excluded due to limited data. The PWV analysis included 6 studies (n=133) and demonstrated a significant increase following exposure to nicotine-containing products (SMD=1.71 [95% CI: 0.23-3.19, p=0.031]). The AIx analysis included 9 studies (n=190) and also demonstrated a significant increase (SMD=1.05 [95% CI: 0.34-1.76, p=0.008]). Metaregression analyses showed no significant moderating effects of publication year, age, or sex. However, small-study effects and substantial heterogeneity were identified.
Discussion:
The study's findings are consistent with previous studies and suggest possible vascular effects of nicotine-containing electronic cigarettes and HTPs. However, limitations require cautious interpretation, and long-term studies are warranted.
Conclusion:
Evidence suggests a possible acute increase in arterial stiffness following exposure to nicotine-containing electronic cigarettes and HTPs compared with non-smokers or nicotinefree electronic cigarette users, but certainty is limited by high heterogeneity, small samples, and methodological variability.
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