Elsevier

International Journal of Cardiology

Volume 343, 15 November 2021, Pages 146-148
International Journal of Cardiology

Short communication
Platelet reactivity is higher in e-cigarette vaping as compared to traditional smoking

https://doi.org/10.1016/j.ijcard.2021.09.005Get rights and content

Highlights

  • E-cigarettes have become a common form of nicotine consumption.

  • Recent studies observed augmented pathologies similar to traditional smoking.

  • Enhanced platelet reactivity in traditional smoking increases ischemic events.

  • Chronic vaping is associated with higher platelet reactivity as compared to traditional smoking and non-smoking.

  • This finding suggests that health effects of vaping might be more severe than previously assumed.

Abstract

Introduction

Vaping emerges as alternative to standard tobacco smoking. However, there is evidence for critical cardiovascular, gastrointestinal and respiratory side effects. Nevertheless, long-term vaping effects on thrombocyte reactivity have not been investigated. Therefore, we investigated the influence of vaping on thrombocyte reactivity in comparison to standard smoking and non-smoking.

Methods

Platelet function was measured by Multiplate Impedance Aggregometry as area under the curve (AUC). Smoking habits and characteristics were assessed by questionnaire. Results were analyzed using inverse probability of treatment weighting (IPTW) and conventional t-tests to test for robustness.

Results

After IPTW adjustment, participants in all groups were balanced by age, gender, body height and weight. Collagen-induced aggregation was higher in vapers compared to non-smokers (non-smokers 52.55 ± 23.97 vs. vapers 66.63 ± 18.96 AUC, p = 0.002) and to smokers (vapers vs. smokers 49.50 ± 26.05 AUC, p < 0.0001). ADP-induced aggregation in vapers was higher compared to non-smokers (non-smokers 33.16 ± 16.61 vs. vapers 45.27 ± 18.67 AUC, p = 0.001) and was numerically increased compared to smokers (vapers vs. smokers 40.09 ± 19.80 AUC, p = 0.08). These findings remained robust in t-test analysis.

Conclusion

This study provides first evidence that vaping leads to enhanced platelet reactivity compared to standard smoking and non-smoking. This suggests health effects of vaping might be more severe than previously assumed. Whether this effect translates to clinical outcome with a higher incidence of major cardiovascular events, should be evaluated in large-scaled clinical studies.

Introduction

E-cigarettes are a common form of nicotine consumption among U.S. adolescents. However, ambiguity exists regarding the impact of vaping versus traditional smoking on cardiovascular risk. Recent studies observed augmented blood pressure, aortic stiffness, inflammatory markers and oxidative stress similar to traditional smoking [1], [2]. Enhanced platelet reactivity in traditional smoking is a major driver of enhanced ischemic events like acute myocardial infarction and stroke [3]. Both traditional smoking of one cigarette or vaping an equal nicotine concentration immediately enhances platelet reactivity [4]. However, chronic effects on platelet function under vaping remain elusive. Therefore, we conducted an explorative pilot analysis, investigating the influence of vaping on platelet reactivity, compared to standard smoking and non-smoking.

Section snippets

Methods

212 healthy individuals were enrolled: 37 non-smokers, 102 vapers and 73 smoked tobacco cigarettes. Inclusion criteria were age > 18 years and consistent smoking habit (non-smoking, tobacco, e-cigarette) for at least 1 year. Smoking habits and characteristics were assessed by questionnaire. Exclusion criteria were intake of antiplatelet medication, non-steroidal anti-inflammatory drugs and known coagulation disorders. Groups were balanced in SPSS statistics and “R” using inverse probability of

Results and discussion

Characteristics did not differ between groups after IPTW. Collagen-induced platelet aggregation was higher in vapers than non-smokers [non-smokers 52.55 ± 23.97 vs. vapers 66.63 ± 18.96 AUC; p = 0.002] or smokers [vapers 66.63 ± 18.96 vs. smokers 49.50 ± 26.05 AUC; p < 0.0001; Fig. 1A]. ADP-induced aggregation in vapers was higher compared to non-smokers [non-smokers 33.16 ± 16.61 vs. vapers 45.27 ± 18.67 AUC; p = 0.001] and smokers [vapers 45.27 ± 18.67 vs. smokers 40.09 ± 19.80 AUC; p = 0.08;

Authorship contributions

D.M., R.M., S.Z., P.M., C.H., D.Z., D.I., A.A. and S.A. designed the study, analyzed and interpreted data, collected data and wrote or revised the manuscript. R.H., T.Z., B.L., T.P., M.K., L.D. and A.P. supervised the study and revised the manuscript.

Disclosures

No conflicts of interest to disclose.

Funding source

This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University (No 29-2019, to L.D., No 18-2019 to A.P.) and by the German Research Foundation (LE 940/7-1 to B.L. and PO 2247/2-1 to A.P. and SFB1116 to A.P. and B.L.).

Ethics committee approval

The study conformed to the Declaration of Helsinki and was approved by the University of Düsseldorf Ethics Committee.

Conflict of interest/disclosures

The authors report no conflict of interest.

Acknowledgements

None.

References (5)

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2

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