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March 20th, 2020:

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Tobacco and Electronic Cigarettes Adversely Impact ECG Indices of Ventricular Repolarization

Tobacco and Electronic Cigarettes Adversely Impact ECG Indices of Ventricular Repolarization: Implication for Sudden Death Risk


Tobacco cigarette(TC) smoking is associated with increased sudden death risk, perhaps through adverse effects on ventricular repolarization(VP). The effect of electronic-cigarettes(ECs) on VP is unknown. Objective To test the hypothesis that TCs and ECs have similar adverse effects on electrocardiogram(ECG) indices of VP, and these effects are attributable to nicotine. Methods ECG recordings were obtained in 37 TC-smokers, 43 EC-users, and 65 non-users. Primary outcomes, Tpeak-to-Tend(Tp-e), Tp-e/QT, and Tp-e/QTc, were measured in TC-smokers pre/post straw-control and smoking one TC, and in EC-users and non-users pre/post straw control and using an EC with and without nicotine(different days). Results Mean values of the primary outcomes were not different among the 3 groups at baseline. In TC-smokers, all primary outcomes including the Tp-e(12.9±5.0%vs1.5±5%, p=0.017), Tp-e/QT (14.9±5.0%vs0.7±5.1%, p=0.004), and Tp-e/QTc(11.9±5.0%vs2.1±5.1%, p=0.036), were significantly increased pre/post smoking one TC compared to pre/post straw-control. In EC-users, the Tp-e/QT(6.3±1.9%, p=0.046) was increased only pre/post using an EC-with-nicotine, but not pre/post the other exposures. The changes relative to the changes after straw-control were greater after smoking the TC compared to using the EC with nicotine for Tp-e(11.4±4.4%vs1.1±2.5%, p<0.05) and Tp-e/QTc(9.8±4.4%vs-1.6±2.6%, p=0.05), but not Tp-e/QT(14.2 ± 4.5%vs4.2±2.6%, p=0.06) . Heart rate increased similarly after the TC and EC-with-nicotine. Conclusions Baseline ECG-indices of VP were not different among TC-smokers, EC-users and non-users. An adverse effect of acute TC smoking on ECG indices of VP was confirmed. In EC-users, an adverse effect of using an EC-with-nicotine, but not without nicotine, on ECG indices of VP was also observed.

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Dependence on e‐cigarettes and cigarettes in a cross‐sectional study of US adults


Background and Aims

Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e‐cigarette use. This study assesses dependence among current and former adult e‐cigarette users on cigarettes and e‐cigarettes, compared with dependence on cigarettes.


Cross‐sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013‐2016. Psychometrically‐assessed dependence was compared for cigarettes and e‐cigarettes among current and former exclusive and dual users of the products, and among e‐cigarette users who had and had not recently stopped smoking.


A population‐based representative sample of US adults.


Participants were 13,311 US adults (18+) in Waves 1‐3 of PATH reporting current established smoking, current use of e‐cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e‐cigarettes.


A 16‐item scale assessing tobacco dependence (on a 1‐5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e‐cigarettes, with a variation assessing residual dependence among users who stopped in the past year.


Among current users, dependence on e‐cigarettes was significantly lower than dependence on cigarettes, in within‐subjects comparisons among dual users of both e‐cigarettes and cigarettes (1.58 [SE=0.05] vs. 2.76 [0.04]), p<0.0001), and in separate groups of e‐cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], p<0.0001), and among both daily and non‐daily users of each product. Among former users, residual symptoms were significantly lower for e‐cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], p<0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], p<0.0001). The highest level of e‐cigarette dependence was among e‐cigarette users who had stopped smoking (2.17 [0.08]).


Use of e‐cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.

COVID-19 and smoking: A systematic review of the evidence

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