Cardiovascular injury induced by tobacco products: Assessment of risk factors and biomarkers of harm. A Tobacco Centers of Regulatory Science compilation

Daniel J. Conklin, Suzaynn Schick, Michael J. Blaha, Alex Carll, Andrew DeFilippis, Peter Ganz, Michael E. Hall, Naomi Hamburg, Tim O’Toole, Lindsay Reynolds, Sanjay Srivastava, Aruni Bhatnagar

Research output: Contribution to journalArticlepeer-review

Abstract

Although substantial evidence shows that smoking is positively and robustly associated with cardiovascular disease (CVD), the CVD risk associated with the use of new and emerging tobacco products, such as electronic cigarettes, hookah, and heat-not-burn products, remains unclear. This uncertainty stems from lack of knowledge on how the use of these products affects cardiovascular health. Cardiovascular injury associated with the use of new tobacco products could be evaluated by measuring changes in biomarkers of cardiovascular harm that are sensitive to the use of combustible cigarettes. Such cardiovascular injury could be indexed at several levels. Preclinical changes contributing to the pathogenesis of disease could be monitored by measuring changes in systemic inflammation and oxidative stress, organ-specific dysfunctions could be gauged by measuring endothelial function (flow-mediated dilation), platelet aggregation, and arterial stiffness, and organ-specific injury could be evaluated by measuring endothelial microparticles and platelet-leukocyte aggregates. Classical risk factors, such as blood pressure, circulating lipoproteins, and insulin resistance, provide robust estimates of risk, and subclinical disease progression could be followed by measuring coronary artery Ca2+ and carotid intima-media thickness. Given that several of these biomarkers are well-established predictors of major cardiovascular events, the association of these biomarkers with the use of new and emerging tobacco products could be indicative of both individual and population-level CVD risk associated with the use of these products. Differential effects of tobacco products (conventional vs. new and emerging products) on different indexes of cardiovascular injury could also provide insights into mechanisms by which they induce cardiovascular harm.

Original languageEnglish (US)
Pages (from-to)H801-H827
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume316
Issue number4
DOIs
StatePublished - Apr 2019

Keywords

  • Cardiovascular
  • Nicotine
  • Risk factors
  • Tobacco

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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