Results of the VESUVIUS trial are adding fuel to the fire in the debate over the impact of electronic cigarettes in former tobacco users.
Jacob George, MD
Despite the obvious negative consequences of vaping, a recent study from the United Kingdom suggests switching from tobacco cigarettes to electronic cigarettes could result in significant improvements in vascular health.
Analysis of the 114 participants included in the randomized trial revealed participants who switched to electronic cigarettes saw improvement in endothelial function and vascular stiffness after just 30 days.
The Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use (VESUVIUS) trial was designed as a prospective randomized controlled trial with a parallel, nonrandomized presence cohort carried out by investigators from the Ninewells Hospital and Medical School at Dundee University. The British Heart Foundation-funded study compared the short-term impact of switching to electronic cigarettes—with or without nicotine—in adults who smoked more than 15 tobacco cigarettes a day for 2 or more years.
Conducted between August 2016 and July 2018, the trial included patients 18 and older, who were free of established cardiovascular disease, diabetes, and chronic kidney disease. Participants who were willing to quit were randomized 1:1 to receive an electronic cigarette with 16 mg of nicotine or an electronic cigarette without nicotine. Participants who were unwilling to quit continued a parallel preference cohort.
Propensity score analysis was performed to adjust for differences between the trial’s randomized groups and preference arms. Flow-mediated dilation and puts wave velocity was used to assess vascular function and investigators measured compliance through assessment of carbon monoxide levels.
The primary outcome measure of the study was change in flow-mediated dilation between the tobacco cigarette group and the nicotine electronic cigarette and nicotine-free electron cigarette arms. Secondary outcome measures included the change in flow-mediated dilation, pulse wave velocity, augmentation index at 75 beats per minute, heart rate, blood pressure, and biomarkers for each of the arms.
Initially, 145 patients were recruited to be part of the study and, of those, 114 patients completed both visits in the study. Of the 114 included, 40 were unwilling to quit, 37 were randomized to electronic cigarettes without nicotine, and 37 received electronic cigarettes with nicotine.
In regard to the primary outcome, investigators observed significant improvements in flow-mediated dilation among patients switching from tobacco cigarettes to electronic cigarettes (1.49%; 95% CI: 0.93 to 2.04; P<0.0001). Results indicated chronic smokers who switched to electronic cigarettes with nicotine had mean improvements of flow-mediated dilation from 5.5% to 6.7% and patients who switched to non-nicotine electronic cigarettes had mean improvements of 5.3% to 6.6%.
Additionally, when comparing the tobacco cigarette arm to the combined electronic cigarette groups, investigators noted improvements in pulse wave velocity (0.529 m/s; 95% CI: 0.946 to 0.112; P=0.014). In participants who smoked more than 20 pack-years, resting heart rate decreased by 2.8 beats per minute (95% CI: 5.2 to 0.4) with electronic cigarettes with nicotine and 5.6 beats per minute with non-nicotine electronic cigarettes(95% CI: 10.4 to 0.8; P=0.02).
This study, titled “Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes,” was published online in the Journal of the American College of Cardiology.