Andrzej Sobczak1, 2
Does switching to electronic cigarettes reduce the harm caused to the cardiovascular system by tobacco smoking?
Czy przejście na elektroniczne papierosy redukuje szkody w układzie sercowo-naczyniowym wywołane paleniem tytoniu?
1Zakład Chemii Ogólnej i Nieorganicznej, Wydział Farmaceutyczny z Oddziałem Medycyny Laboratoryjnej, Śląski Uniwersytet Medyczny w Katowicach
2Zakład Szkodliwości Chemicznych i Toksykologii Genetycznej, Instytut Medycyny Pracy i Zdrowia Środowiskowego w Sosnowcu
Streszczenie
Największa liczba przedwczesnych zgonów w wyniku palenia czynnego i palenia biernego następuje w wyniku chorób sercowo-naczyniowych. Wprowadzenie w ostatniej dekadzie na rynek konsumencki alternatywnych form dostarczania nikotyny wywołało ożywioną dyskusję dotyczącą szkodliwości tych wyrobów. W prezentowanej pracy poglądowej porównano mechanizmy negatywnego wpływu dymu tytoniowego i aerozolu generowanego z elektronicznych papierosów na układ sercowo-naczyniowy. Przytoczono opinie autorytetów z dziedziny kardiologii oraz prestiżowych organizacji i instytucji, dotyczące tego zagadnienia. Dokonano oceny redukcji szkód w układzie sercowo-naczyniowym po zastąpieniu przez palacza papierosów konwencjonalnych papierosami elektronicznymi. Dostępne wyniki badań wskazują, że główną przyczyną negatywnego wpływu aerozolu z elektronicznych papierosów na układ sercowo-naczyniowy jest nikotyna. Brak procesu spalania w elektronicznych papierosach powoduje, że ogromna ilość związków z dymu tytoniowego nie występuje w aerozolu. Oznacza to znacznie słabsze oddziaływanie tej grupy związków na układ sercowo-naczyniowy. W konsekwencji zastąpienie palenia tytoniu elektronicznymi papierosami lub innymi bezdymnymi formami przyjmowania nikotyny powinno prowadzić do zmniejszenia ryzyka powstania chorób sercowo-naczyniowych, jednakże go nie eliminując.
Summary
The largest number of premature deaths associated with active and passive smoking are due to cardiovascular diseases. The introduction of alternative nicotine delivery devices to the consumer market over the last decade has inspired a vivid debate on the harmfulness of these products. This review compares the mechanisms of the negative influence of tobacco smoke and the aerosol generated from electronic cigarettes on the cardiovascular system. The opinions of authorities in cardiology, as well as those of prestigious organisations and institutions on the matter, are quoted in the paper. Harm reduction following the replacement of conventional cigarettes with electronic ones has been assessed. Available research shows that the main cause of the negative effects of the aerosol from electronic cigarettes to the cardiovascular system is nicotine. No combustion process in electronic cigarettes results in the lack of a vast amount of smoke compounds normally found in cigarette smoke. This results in a smaller influence of these compounds on cardiovascular system. As a consequence, substituting cigarette smoking with electronic cigarettes or other smokeless tobacco products should lead to a reduction in the risk of cardiovascular diseases, however, not to eliminating the risk.
Introduction
The number of deaths due to smoking illustrates the enormously negative effect of tobacco smoke on health. It is estimated that between 1964 and 2014 nearly 21 million USA residents died prematurely as a result of smoking. Cardiovascular and metabolic diseases accounted for the premature death of 7.8 million Americans, cancer for 6.58 million and respiratory diseases for 3.8 million Americans. Cases of premature death also included 2.5 million passive smokers, 108,000 children and 86,000 victims of fire caused by cigarette butts (1). It is estimated that every year 480,000 individuals die in the United States as a result of smoking-related diseases. In the European Union tobacco consumption is responsible for 700,000 deaths every year and it is estimated that smokers live 14 years shorter than they could (2).
Smokers most commonly associate tobacco smoking with lung cancer. However, it is cardiovascular diseases (CVD) that account for the largest proportion of smoking-related deaths (fig. 1).
Fig. 1. Proportion of deaths due to diseases caused by active and passive exposure to tobacco smoke in 1965 – 2015; based on (1)
The reason for the negative impact of tobacco smoke on the cardiovascular system is the substantial amount of toxic compounds inhaled by the smoker. In 2012 the U.S. Food and Drug Administration (FDA) published a list of 93 harmful and potentially harmful constituents (HPHCs) present in tobacco smoke and tobacco (3). Each of them was assessed for carcinogenicity, addictive properties as well as respiratory, reproductive or developmental and cardiovascular toxicity. In the case of cardiovascular toxicity 12 substances were selected which include 4 compounds from the polycyclic aromatic hydrocarbon (PAH) group. Their presence in tobacco smoke is the result of chemical transformations which occur during the smoking of tobacco products.
Smoking-related mechanisms which lead to cardiovascular diseases
The toxic components of tobacco smoke affect the smoker’s body in multiple ways. This multiplicity of effects is associated with the fact that tobacco smoke includes an enormous number of chemical substances of various types which contain various reactive chemical groups (hydroxyl, carboxyl, amine, aldehyde, thiol) and a large group of free radicals. Many of them can have a direct effect on the haemodynamics of circulation, affect the lipid balance, disrupt homeostasis systems and cause lesions in the vascular endothelium. It is important since vascular endothelial dysfunction is treated by many authors as the fundamental component of cardiovascular disease pathogenesis. Vascular endothelial dysfunction has even been described as ‘the risk of the risk factors’, which shows that it is of fundamental importance for the future development of vascular lesions leading to the formation of atherosclerotic plaque (4). The basic mechanisms mediating the effects of tobacco smoke on the cardiovascular system include (5):
– vascular endothelial damage and dysfunction,
– change in the concentration of atherogenic plasma lipoprotein fractions,
– haemodynamic stress,
– oxidative stress,
– activation of neutrophils,
– increase in blood coagulability,
– increase in fibrinogen concentration and blood viscosity.
According to a report of the Surgeon General of the United States (1), the whole mechanism through which tobacco smoking affects the cardiovascular system is very complex but well-documented (fig. 2a). New research indicating a cause-and-effect relationship between smoking and CVD which has been conducted in recent years does not challenge this mechanism (6-8).
Fig. 2a, b. Comprehensive mechanism mediating the effects of tobacco smoke (a) and e-cigarette aerosol (b) on cardiovascular function; based on (1,17)
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Piśmiennictwo
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2. Special Eurobarometer 458 „Attitudes of Europeans towards tobacco and electronic cigarettes” Report. European Union, 2017; http://ec.europa.eu/COMMFrontOffice/PublicOpinion.
3. Food and Drug Administration: Harmful and potentially Harmful Constituents in Tobacco Products and Tobacco Smoke. Established List. Federal Register 2012; 77(64): 20034-20037.
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