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BACKGROUND: Electronic cigarettes (e-cigarettes) are nicotine delivery systems that generate an aerosol that can be inhaled and come in a variety of attractive designs and e- liquid flavorings. E-cigarettes are the second most commonly used tobacco product in the United States and are predominantly used by youth and young adults. The cardiovascular health risk of combustible cigarette use is well-established, but whether e-cigarettes increase the risk of cardiovascular events is less clear. Evaluating the short-term vascular effects of e-cigarette use is an approach to gain insight into the cardiovascular health impact. Limited studies have shown that acute e-cigarette use in combustible cigarette users was associated with increased central hemodynamic values and arterial stiffness. Few studies have assessed the effects of chronic e-cigarette use on arterial stiffness, particularly in young adults. OBJECTIVE: To assess the effects of e-cigarette use on central hemodynamics and arterial stiffness in regular e-cigarette users in comparison to combustible cigarette users and non-users. METHODS: Combustible cigarette users, e-cigarette users, and non-users without known cardiovascular disease (CVD) or CVD risk factors between the ages of 18 and 45 were enrolled in the ongoing Cardiovascular Injury due to Tobacco Products 2.0 (CITU 2.0) study at the Boston University School of Medicine and the University of Louisville School of Medicine starting from 2019. Non-invasive arterial tonometry, using the SphygmoCor system, was performed to measure peripheral artery waveforms to obtain central hemodynamic values and arterial stiffness parameters: augmentation index (AIx), carotid-radial (CR) and carotid-femoral pulse wave velocities (CFPWV). RESULTS: We had available arterial stiffness measures in 209 study participants (mean age 26±7, 48% female) across 3 tobacco product use groups: combustible cigarette users (N=51), e-cigarette users (N=97), and non-users (N=61). Amongst the e-cigarette users, 41 were dual users (use of both e-cigarettes and combustible cigarettes), 25 were exclusive e-cigarette users who were former combustible cigarette users, and 31 were exclusive e-cigarette users who were never combustible cigarette users. The majority (87%) of e-cigarette users used a pod-based product with fruit and mint/wintergreen or menthol as the most popular e-liquid flavors. In unadjusted analyses, central systolic blood pressure, AIx, CRPWV, and CFPWV differed across the three tobacco product use categories. In multivariable regression models adjusting for age, sex, race and study site, e-cigarette users and combustible cigarette users had higher central systolic blood pressure (β=3.9±2.0, p=0.048 and β=4.8±2.4, p=0.04, respectively) whereas combustible cigarette smokers also had higher central AIx, and CRPWV compared to non-users (β=6.9±3.3, p=0.04 and β=0.97±0.31, p=0.002, respectively). In unadjusted analyses across the five groups, we found similar patterns of differences in vascular measures. In multivariable regression models comparing to combustible cigarette users, dual product users had similar measures of vascular function whereas exclusive e-cigarette users who were former smokers had lower CRPWV (β=-0.95±0.36, p=0.009), and exclusive e- cigarette users who were never combustible cigarette users had lower AIx (β=-9.0±4.2, 0.04). CONCLUSIONS: Our findings suggest that in young adults, combustible cigarette use is associated with measures of arterial stiffness. Dual e-cigarette use was largely similar to combustible cigarette use whereas exclusive e-cigarette use had a lesser degree of vascular stiffening. Further studies are needed to evaluate the long-term impact of e- cigarette use on cardiovascular health.

Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry. In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65–72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices. In VI, both baPWVand cfPWVinter-correlatedwell and showed good level of agreement with bilateral baPWVmeasured byVE (baPWV[VI]– baPWV[VE]R: overall concordance correlation coefficient [OCCC]¼0.484, mean difference¼1.94 m/s; cfPWV[VI]–baPWV[- VE]R: OCCC¼0.493, mean difference¼1.0m/s). In contrast, SSBO derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r¼0.196; P¼0.04) and ipsilateral baPWV (cf/ aoPWV[VE]R–baPWV[VE]R: r¼0.166; P¼0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r¼0.725, P<0.001). AI exhibited marginal between-device agreement (right-sided: OCCC¼ 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver–OCCC[VI] vs [VE]¼0.774 vs 0.844; intraobserver OCCC[VI] vs [VE]¼0.613 vs 0.769). Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.

Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry. In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65–72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices. In VI, both baPWVand cfPWVinter-correlatedwell and showed good level of agreement with bilateral baPWVmeasured byVE (baPWV[VI]– baPWV[VE]R: overall concordance correlation coefficient [OCCC]¼0.484, mean difference¼1.94 m/s; cfPWV[VI]–baPWV[- VE]R: OCCC¼0.493, mean difference¼1.0m/s). In contrast, SSBO derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r¼0.196; P¼0.04) and ipsilateral baPWV (cf/ aoPWV[VE]R–baPWV[VE]R: r¼0.166; P¼0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r¼0.725, P<0.001). AI exhibited marginal between-device agreement (right-sided: OCCC¼ 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and inter-observer concordances were similarly high except for AI yielding a trend toward better reproducibility in VE (interobserver–OCCC[VI] vs [VE]¼0.774 vs 0.844; intraobserver OCCC[VI] vs [VE]¼0.613 vs 0.769). Both diastolic oscillometry-derived PWV modes, and AI measured either with VI or VE, are comparable and reliable alternatives for the assessment of arterial stiffness. Aortic PWV assessed by SSBO in VE is not related to the corresponding indices determined by traditional diastolic oscillometry.

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