Editorial Commentary: Nicotine in Electronic Cigarettes: Cardiovascular Harm Reduction, Not Eliminat
Monday, August 15, 2016
Posted by: Natalia Gromov
Hilary Aurora Tindle, MD, MPHn and Matthew S. Freiberg, MD, MSc
Editorial Commentary: Nicotine in Electronic Cigarettes: Cardiovascular Harm Reduction, Not Elimination.
T R E N 2 D S I N C A R D I O V A S C U L A R M E D I C I N E 2 0 1 6. http://dx.doi.org/10.1016/j.tcm.2016.03.013
In this issue of Trends in Cardiovascular Medicine, Benowitz and Burbank  offer a fresh look at potential consequences of chronic exposure to an old drug, nicotine, in a relatively new delivery system, electronic cigarettes, also called electronic nicotine delivery systems (ENDS). This timely state-ofthe-science piece on nicotine and cardiovascular disease frames an important component of the ongoing debate about prolonged use of non-combustible (smokeless) nicotine products and harm reduction: how safe are they? The review focuses appropriately on the implications of this question vis-à-vis ENDS, whose use continues to rise precipitously worldwide. In the United States alone, 21.6% of adults aged 18–24 years  and two million children  use ENDS, and use by youth not only doubled from 2011 to 2013 , but recently surpassed traditional cigarettes. Continued rise in prevalence is expected into the next generation, spurred on by aggressive advertising campaigns that now reach seven of ten children of middle and high school age ; controversial data suggest that ENDS could serve as a gateway to subsequent and/or concomitant use of other tobacco products . While precise patterns and duration of their use have not been elucidated, the epidemiologic evidence and economic forecasting  virtually guarantee a substantial cohort of long-term ENDS users, a fact that warrants a thorough review of the pharmacology, pharmacokinetics, and cardiovascular actions of nicotine itself. The key question raised by the prospect of a generation of ENDS users is the extent to which prolonged nicotine exposure—even without the smoke—may cause cardiovascular harm.