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- Antoniewicz, Lukasz, et al.
(author)
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Brief exposure to Swedish snus causes divergent vascular responses in healthy male and female volunteers
- 2018
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In: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:4
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Journal article (peer-reviewed)abstract
- Introduction: The use of Swedish oral moist snuff, known as snus, has for a long time been limited to the Scandinavian countries. With declining cigarette sales in the western world, tobacco companies have looked to the development of alternative tobacco products. In 2006 snus products were launched in the US. Even though several studies have demonstrated negative health effects, snus is often depicted as harmless.The aim of the present study was to investigate acute vascular effects of snus as measured by arterial stiffness as well as blood pressure and heart rate.Methods: Two separate randomized double-blind crossover studies with the same study design were pooled for analysis. Twenty-nine healthy snus-users (17 females, 12 males) were included. Snus (Göteborgs Rapé) and tobacco free snus (Onico) were administered in a randomized order at two separate visits. Arterial stiffness, blood pressure and heart rate were measured at baseline as well as every five minutes for 40 minutes during exposure. Following snus removal, measurements continued for 30 minutes post exposure. Arterial stiffness was measured using pulse wave velocity (Vicorder) and pulse wave analysis (Sphygmocor).Results: Compared to placebo, snus significantly increased systolic and diastolic blood pressure as well as heart rate, however, only in females (p = 0.004, p = 0.006 and p<0.001 respectively). No changes were seen in arterial stiffness measurements in either gender.Conclusion: We observed an increase in blood pressure and heart rate only in females, but not in males due to snus usage as compared to placebo. This novel finding was surprising and needs to be further investigated considering most of the earlier studies have mainly focused on male snus users and the increasing usage of snus among females.
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| 2. |
- Antoniewicz, Lukasz
(author)
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Effects of cigarettes, e-cigarettes and Swedish snus on vascular function
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Cigarette smoking is considered one of the leading causes of preventable morbidity and premature death worldwide. A large portion of this is attributable to cardiovascular disease such as ischemic heart disease and stroke. However, with the public’s increasing awareness of the harm and diseases related directly to cigarette smoke, alternative combustion-free nicotine delivery products have gained in popularity. Two of the products which have seen substantial market growths during the last few years are Swedish snus and electronic cigarettes. In recent years, an increasing number of studies have demonstrated a correlation between snus usage and increased mortality in coronary heart disease and stroke. Although there are studies with contradictory results, regarding the general underlying increase of cardiovascular risk. So far, there is limited data available on the potential negative health effects of e-cigarette smoking. The overall aim of this thesis was to investigate vascular health effects caused by acute cigarette and e-cigarette inhalation as well as chronic snus usage. Methods and Results: In Paper I, twelve healthy volunteers were subjected to cigarette smoking or not-smoking in a cross-over study. Microvesicles and endothelial progenitor cells were analyzed in collected blood samples at baseline and 1h, 4h and 24h following exposure. Cigarette smoking caused an acute increase in endothelial progenitor cells and in microvesicles of platelet, leukocyte and endothelial origin. Paper II was a randomized, cross-over study where 16 healthy volunteers were exposed to electronic cigarette inhalation with nicotine vs non-inhalation. Biomarkers were analyzed in the same approach as in Paper I. E-cigarette inhalation caused an acute increase in endothelial progenitor cells. Microvesicles, with the exception of endothelial derived microvesicles, were unaffected. In Paper III, seventeen healthy volunteers inhaled e-cigarette vapor with and without nicotine. In this double-blinded, randomized, cross-over study arterial stiffness was analyzed at baseline and at predetermined intervals for 4 hours following exposure. E-cigarette vapor inhalation containing nicotine caused a transient acute increase in heart rate and arterial stiffness. Paper IV was a cross-sectional study investigating healthy long-term snus users (mean age 44.8 years) and age-matched controls. Arterial stiffness, forearm blood flow as well as fibrinolytic function and endothelial progenitor cells in blood samples were analyzed. Snus users had significantly higher arterial stiffness as well as impaired endothelial function, i.e. decreased forearm blood flow upon glyceryl tri-nitrate infusion. There was no difference in fibrinolytic function and endothelial progenitor cells between the two groups. Discussion: Smoking a single cigarette causes a rapid activation of endothelial cells, platelets and leukocytes. As cigarette smoking has known detrimental effects on vascular health, our results were not unexpected. However, e-cigarette inhalation as well as smoking a conventional cigarette, causes a similar swift mobilization of endothelial progenitor cells. This may be interpreted as an acute endothelial stress caused by nicotine. Furthermore, inhaled nicotine is linked to increases in arterial stiffness, which is chronically altered in daily snus users. This elucidates that nicotine alone may alter endothelial function, both upon acute and chronic exposure. Snus users also display an attenuated effect of glyceryl tri-nitrate which further strengthens the findings that snus use is associated with increased mortality following myocardial infarction. In summary, we demonstrate that the nicotine content in combustion-free nicotine delivering products may alter vascular function. E-cigarettes and snus should therefore not be considered as harmless recreational products.
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| 3. |
- Lundback, Magnus, et al.
(author)
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Acute effects of e-cigarette inhalation with or without nicotine on levels of microvesicles in the blood of human volunteers
- 2018
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In: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Journal article (other academic/artistic)abstract
- Background: The e-cigarette use has increased dramatically. Our group has demonstrated signs of possible vascular damage following e-cigarette use.We study the effects of e-cigarette inhalation (vaping) on vascular function, inflammation and hemostasis. Microvesicles (MV) of endothelial, leukocyte and platelet origin is measured in blood. MV are biomarkers that reflect cell function and can be used when assessing the risk of cardiovascular complications. We have recently shown that cigarette smoking causes an acute increase in MV in blood of healthy volunteers, suggesting vascular injury, inflammation and negative impact on hemostasis. We now investigate if the e-cigarette has similar effects.Methods: Seventeen healthy sporadic smokers vaped 30 puffs from an e-cigarette with and without nicotine in a crossover fashion. Blood sampling was performed at 0, 2, 4 and 6 hours following exposures. MVs was determined by flow cytometry and measured from platelets (PMV), leukocytes (LMV) and endothelial cells (EMV).Results: Inhalation of e-cigarettes containing nicotine caused a significant increase in PMV and EMV over time. PMV that exposed P-selectin and/or CD40L increased significantly as well. Nicotine free e-cigarette vapour did not cause a significant increase in PMV and EMV over time.Discussion: As little as 30 puffs of nicotine containing e-cigarette vapor cause increased levels of circulating MVs of endothelial and platelet origin, indicating possible vascular injury. This may lead to increased progression of atherosclerosis, the underlying cause of myocardial infarction and stroke.
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