Electronic Cigarettes: Nicotine Comes Around Again

The next issue of The Medical Letter includes an article on electronic cigarettes, which have lately received considerable space in the popular press. With LED bulbs at their tips and flavors like chocolate, it becomes easy to forget that what they bring to the table is nicotine, which has caused a lot of trouble in its day.

Researching our article led us to an excellent old (1998) book called Nicotine Safety and Toxicity, edited by Neal L. Benowitz, which does a fine job of teasing out the toxicity of nicotine, particularly its cardiovascular toxicity, from that of all the other toxins found in cigarette smoke. The increased incidence of cardiovascular disease in smokers, including myocardial infarction, stroke, and peripheral vascular disease, is well documented, but the exact cause is unclear.

Benowitz points out that carbon monoxide and oxidant gases are plausible contributors, in addition to nicotine. But he goes on to describe the many physiologic effects of nicotine that could precipitate or aggravate cardiovascular disease, starting with increased sympathetic outflow from the CNS and increased release of catecholamines from the adrenals, which lead to an increase in heart rate and blood pressure, increased myocardial contractility, and constriction of blood vessels, including the coronaries. Coronary vasoconstriction clearly could cause myocardial ischemia, and high levels of catecholamines could lead to cardiac arrhythmias.

The levels of nicotine in electronic cigarettes may be lower than those in tobacco cigarettes, but the degree of systemic exposure to nicotine varies markedly with the rapidity of dosing. Inhaling a nicotine-containing vapor into the lungs guarantees rapid absorption and higher systemic levels than a dermal patch or chewing gum could achieve. Tolerance develops to the physiologic effects of nicotine, but it is not complete.

At the moment, the FDA has not established regulatory authority over electronic cigarettes, which are available over the counter in stores and on the internet. In some states, any child can buy them. I would expect that situation to be remedied soon, but still…. Who needs this, all over again?

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Comments

  1. Barry S Gloger, MD says:

    In addition, I worry about the second hand “smoke” or vapors exhaled by e-cigarette users. In addition to nicotine, there are flavor enhancers and god knows what chemicals designed to addict users. That’s why the use of e-cigarettes needs to be banned in public.

  2. Trading one addiction for another

  3. Electronic cigarettes come with different nicotine strengths and have many advantages over traditional smoking. No doubt, these may be addictive but their consumption is much less harmful than traditional cigarettes.

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