No adverse effects on coronary microcirculation electronic cigarettes

Dr Konstantinos Farsalinos

"This study adds to currently available evidence that supports that electronic cigarettes are significantly less harmful compared with tobacco," Dr Konstantinos Farsalinos(Onassis Cardiac Surgery Center, Kallithea, Greece) said here at the European Society of Cardiology (ESC) 2013 Congress. "Monitoring of consumers for several years will determine the long-term effects of electronic cigarette use."

At last year's ESC meeting, Farsalinos presented the results of a small study comparing effects on left ventricular function, blood pressure, and heart rate in 40 subjects, as reported by heartwire.

At this year's meeting, Farsalinos presented an analysis, this time in 60 subjects, looking at coronary flow velocity reserve (CFVR) and coronary vascular resistance index (CVRI). Thirty subjects were current smokers; in this group, CFVR/CVRI was measured in response to adenosine administration, 20 to 30 minutes after smoking two cigarettes and after using an electronic cigarette. Another 30 patients, made up of patients who had had their last cigarette at least one month previously, underwent the same tests, 20 to 30 minutes after using an electronic cigarette. Nonuse of cigarettes in this group was confirmed via testing of carboxyhemoglobin levels.

As Farsalinos showed here, no differences in CFVR and CVRI were seen following e-cigarette use, both in the nonsmoking group and in the group of smokers who were also studied after trying the e-cigarette. By contrast, smokers saw a 16% decrease in CFVR (p<0.001) and a 19% decrease in CVRI (p<0.001) 20 to 30 minutes after smoking their two cigarettes.

Harm reduction?
"The electronic cigarette is not a product that is recommended for everyone as a new habit, it is recommended for smokers as an alternative to smoking to reduce consumption or to quit," Farsalinos said. "It is not for the general population; that should be clear."

Farsalinos acknowledged that the devices do emit low levels of harmful substances in addition to nicotine. "Both formaldehyde and acrolein have been found," he said. "They are produced in the heating and evaporation process, so they are not present in the liquid, but in the vapor. But the levels in electronic cigarettes are from 10 to 400 times lower compared with tobacco. The same was observed with nitrosamines, which are approximately 500 to 1000 times lower compared with tobacco cigarettes.

"The presence of such chemicals are found in very low levels; so we have to see for a long period of years if there are complications. But we can say [with confidence] that they are by orders of magnitude lower, and most likely it would be beneficial for smokers to switch to electronic cigarettes if they cannot quit by other methods."

Wait and see


Industry Is Winning the E-Cig Regulation Battle

Correction appended: June 12, 2014

Naturally, one of the biggest concerns among health advocates is children’s access to e-cigarettes—and marketing of e-cigs to teens is up 321%, as TIME recently reported. The Centers for Disease Control and Prevention estimates that almost 2 million students in the U.S. have tried e-cigarettes. Policies to address the issue run the gambit from the least controversial—like establishing an age restriction on purchasing e-cigs and child proof packaging—to the more divisive, like prohibiting marketing to teens, prohibiting internet sales, and restricting the use of kid-friendly candy-like flavors.“The deeming rule that the FDA has proposed is very, very, very limited in its scope,” says Stanton Glantz, a cardiology professor at the University of San Fransisco and one of the most vociferous proponents of strict rules for e-cigs. “It requires a useless warning label and says they can’t be sold to kids under 18, but it doesn’t put any restrictions on internet sales, which means kids under 18 can easily get them. It has no restrictions on marketing at all.” This puzzles Glantz. “You would think that the Obama administration would be supporting tobacco control because it would reduce health care costs.” As far as Glantz is concerned, the administration has erred on the side of the tobacco interests.So far, it looks like the businesses are winning. When the FDA first announced the start of the rule-making process, Time wrote about the positive reaction to them by e-cigarette executives, who saw them as a reasonable first step that would not greatly interfere with their businesses. Now, a few weeks into the rule-making process, business continues to be optimistic while public health advocates are getting worried.

But even the most basic restrictions—like better product labeling, and child proofing—were absent from the FDA’s initial deeming rules, making other restrictions on advocates’ wish lists seem that much further away. “Any meaningful rules on marketing of e-cigarettes are years, and years, and years away,” says Glanz, pointing out that if restrictions were imposed, e-cog companies would likely sue over marketing restrictions on first amendment grounds.

Craig Weiss, the CEO of NJOY in Scottsdale, Arizona, one of the leading electronic cigarette brands, also thinks the FDA rules will stay fairly restrained. “The FDA are smart people,” he says. “They have to read everything and they will, but I think what you saw in the proposed regulations, that’s what you are going to see in the ultimate regulations as well.”

As for whether any child-marketing restrictions would make sense down the line, Weiss says there are appropriate curbs, but there is no reason e-cigarette marketing should be as strict as tobacco. “You are confusing the arsonist with the firefighter,” he says. “Why would you treat products that are part of the solution as products that are part of the problem?” he says. Though NJOY is careful not to make direct claims that their products can help smokers quit, Weiss is a big believer in the potential for electronic cigarettes to replace cigarettes. Weiss supports limits on the age of actors in ads and rules against e-cigs appearing in cartoons, but he rejects the idea that there is anything wrong with his ads, which do feature young adults.

That’s not good enough for public health advocates. “The best way to market to kids is to market to young adults,” says Glantz, “If you designed marketing to stop smoking in a 50 year old, it could be done. That’s not what they are doing. It wouldn’t be on MTV, it would be on evening news.”
Weiss responds: “I’m interested in converting every adult smoker in the country to these products. I think it would be a tragedy for smokers to be smokers for decades before we advertise in a way that is appealing to them.”
The battle over e-cig regulation isn’t settled, but if what’s going on now is any indication, that battle may have actually been over—and won by industry—before it even started.Correction appended: The original version of this story incorrectly described which restrictions are absent from the FDA’s initial deeming rules 


How e-cigarette companies are quietly winning the war on regulation

Electronic cigarette organizations are quietly winning the war on regulation by effectively campaigning state governing bodies to avoid them from tobacco control laws.
Open wellbeing authorities and without smoke backers say industry-supported bills have the lacquer of open wellbeing with procurements about banning deals to minors—however keep away from the more stringent standards other tobacco items must maintain.
"These are Trojan Horse charges that look great yet leave yawning gaps openly wellbeing regulations," said Vince Willmore of Tobacco Free Kids. "They bring about distinctive punishments and authorization from general tobacco items, they absolved e-cigarettes from being incorporated in without smoke air laws, and some excluded producers from state charges also. The World Health Organization has called e-cigarettes well-being "illusive", since the parts they hold are not generally unveiled and there is not "satisfactory information on discharges." When it comes to helping individuals quit smoking, they additionally say the science is not indisputable. The US Centers for Disease Control takes a comparable stance: that there is insufficient confirmation to comprehend the wellbeing effect of vaping. They caution of the potential for nicotine dependence, harming, and call for more vigorous regulation.
"These strategies to undermine successful arrangements stand to make smoking and the conduct of smoking socially adequate once more," said Cathy Callaway, partner executive of state and nearby fights for the American Cancer Society Cancer Action Network. "On the off chance that the business can keep individuals dependent on tobacco items, they'll be more inclined to keep on purchasing items, and the business profits."
E-cigarette organizations contend that these state regulations are great confidence deliberations to keep kids safe. "Not just have we underpinned state enactment to keep the offer of e-cigs to youth, however we have additionally put set up a vigorous age check process on the web, like retail," Jason Healy, the president of Bluecigs, said in an announcement. Please visit the following  websites for more details about ecigs: google ,wikipedia, AOL search,dual coil, bing search, yahoo .
"In the matter of advertising," he included, "we have deliberately embraced strict showcasing confinements, for example, constraining our notice situation to media and occasions where the intended interest group comprises of no less than 85 percent grown-ups."
Willmore at Tobacco Free Kids is suspicious of these exertions. He said they disaffirm the steps taken by industry to snare individuals while they are youthful. "E-cigs are replicating the tobacco organization's playbook to market to children. They're utilizing VIP supports, cartoon pitches. They're supporting auto races and music celebrations. They're utilizing this wild cluster of sweet flavors like cotton confection and sticky bears that have been banned from standard cigarettes."


E-Cigarette Makers Are in an Arms Race for Exotic Vapor Flavors

Twista Lime, Kauai Kolada, Caribbean Chill, Mintrigue. Exotic cigarette flavors like those were banned in 2009 out of concern they might tempt young people.
But the flavors tobacco companies once sold look like plain vanilla compared with the flavor buffet now on offer — legally — by the fast-growing electronic cigarette industry.
News on Tuesday that Reynolds American had agreed to buy Lorillard, uniting two of the nation’s biggest tobacco companies, highlighted how important e-cigarettes have become to the declining tobacco industry. Both Reynolds and Lorillard have pushed hard into e-cigarettes, which offer a new way of delivering a puff of nicotine.
For now, those companies’ flavors are relatively modest, though they may feel pressure to expand into the explosion of competition for the consumer palate, with e-cigarette flavors such as banana cream pie and cotton candy.

Across the e-cigarette industry, more than 7,000 flavors are now available and, by one estimate, nearly 250 more are being introduced every month. The array of tastes goes far beyond anything cigarette companies ever tried.


A technician filling bottles with the flavored nicotine-laced liquid for electronic cigarettes at a plant in Miami. 
Joe Raedle/Getty Images

Flavors have become central to the conversation because e-cigarette makers say that the rainbow of tastes differentiates them from deadly cigarettes.
But the claim that e-cigarette flavors won’t attract children has prompted an outcry from some policy makers, who say consumers have been down this road before with tobacco. Federal health authorities have outlawed most cigarette flavorings except menthol, arguing that they lure the young into nicotine addiction. While the Food and Drug Administration has proposed regulations for e-cigarettes, it has not limited marketing or flavors, which the agency is studying.
At a Senate committee hearing in late June, lawmakers denounced manufacturers for marketing practices that they said appealed to children, including the embrace of flavors that are forbidden in ordinary cigarettes.Jason Healy, the president of Blu eCigs, told the Senate Committee on Commerce, Science and Transportation that the average age of people using cherry flavored e-cigarettes, for example, was 40. Such flavors “decrease the ability or possibility of adult users who use e-cigs switching back” to cigarettes, he said. Blu eCigs, a subsidiary of Lorillard, is being sold to the British company Imperial as part of the deal announced on Tuesday. Lorillard and Reynolds said they would focus their e-cigarette efforts on Reynolds’ product Vuse, which in June was introduced in 15,000 stores nationwide.
For now, Vuse has only two flavors, original cigarette flavor and menthol, but the market is changing quickly as evidenced by the experience of other leading e-cigarette companies. Most notable is the experience of NJOY, which has turned to flavors to help stanch plummeting market share.


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