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Master of Public Health

Cardiovascular injury induced by tobacco products: Assessment of risk factors and biomarkers of harm A Tobacco Center of Regulatory Science (TCORS) Compilation

AUTHORS

Conklin DJ , Schick SF , Blaha MJ , Carll AP , DeFilippis A , Ganz P , Hall ME , Hamburg NM , O'Toole TE , Reynolds LM , Srivastava S , Bhatnagar A , . American journal of physiology. Heart and circulatory physiology. 2019 2 1; ().

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, while organ-specific dysfunctions could be gauged by measuring endothelial function (flow-mediated dilation), platelet aggregation, and arterial stiffness; whereas, 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 calcium 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 indices of cardiovascular injury could also provide insights into mechanisms by which they induce cardiovascular harm.

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