Evidence relating cigarettes,cigars and pipes to cardiovascular disease and stroke:Meta-analysis of recent data from three regions

BACKGROUND More recent data are required relating to disease risk for use of various smoked products and of other products containing nicotine.Earlier we published metaanalyses of recent results for chronic obstructive pulmonary disease and lung cancer on the relative risk(RR)of current compared to never product use for cigarettes,cigars and pipes based on evidence from North America,Europe and Japan.We now report corresponding up-to-date evidence for acute myocardial infarction(AMI),ischaemic heart disease(IHD)and stroke.AIM To estimate,using recent data,AMI,IHD and stroke RRs by region for current smoking of cigarettes,cigars and pipes.METHODS Publications in English from 2015 to 2020 were considered that,based on epidemiological studies in the three regions,estimated the current smoking RR of AMI,IHD or stroke for one or more of the three products.The studies should involve at least 100 cases of stroke or cardiovascular disease(CVD),not be restricted to populations with specific medical conditions,and should be of cohort or nested case-control study design or randomized controlled trials.A literature search was conducted on MEDLINE,examining titles and abstracts initially,and then full texts.Additional papers were sought from reference lists of selected papers,reviews and meta-analyses.For each study identified,we entered the most recent available data on current smoking of each product,as well as the characteristics of the study and the RR estimates.Combined RR estimates were derived using random-effects meta-analysis for stroke and,in the case of CVD,separately for IHD and AMI.For cigarette smoking,where far more data were available,heterogeneity was studied by a wide range of factors.For cigar and pipe smoking,a more limited heterogeneity analysis was carried out.A more limited assessment of variation in risk by daily number of cigarettes smoked was also conducted.RESULTS Current cigarette smoking:Ten studies gave a random-effects RR for AMI of 2.72[95%confidence interval(CI):2.40-3.08],derived from 13 estimates between 1.47 and 4.72.Twenty-three studies gave an IHD RR of 2.01(95%CI:1.84-2.21),using 28 estimates between 0.81 and 4.30.Thirty-one studies gave a stroke RR of 1.62(95%CI:1.48-1.77),using 37 estimates from 0.66 to 2.91.Though heterogeneous,only two of the overall 78 RRs were below 1.0,71 significantly(P<0.05)exceeding 1.0.The heterogeneity was only partly explicable by the factors studied.Estimates were generally higher for females and for later-starting studies.They were significantly higher for North America than Europe for AMI,but not the other diseases.For stroke,the only endpoint with multiple Japanese studies,RRs were lower there than for Western studies.Adjustment for multiple factors tended to increase RRs.Our RR estimates and the variations by sex and region are consistent with earlier meta-analyses.RRs generally increased with amount smoked.Current cigar and pipe smoking:No AMI data were available.One North American study reported reduced IHD risk for non-exclusive cigar or pipe smoking,but considered few cases.Two North American studies found no increased stroke risk with exclusive cigar smoking,one reporting reduced risk for exclusive pipe smoking(RR 0.24,95%CI:0.06-0.91).The cigar results agree with an earlier review showing no clear risk increase for IHD or stroke.CONCLUSION Current cigarette smoking increases risk of AMI,IHD and stroke,RRs being 2.72,2.01 and 1.62.The stroke risk is lower in Japan,no increase was seen for cigars/pipes.

Toxicology of Commonly Found Ingredients in E-Cigarettes: A Brief Review

Electronic cigarettes (EC) have gained popularity among smokers due to their taste, smell, appearance, and easy availability compared to traditional cigarettes, as well as the perception that they are safer than traditional cigarettes. These devices result in aerosols containing nicotine, propylene glycol, glycerin, ethylene glycol, vitamin E, and chemical flavors inhaled into the lungs. Other components found in these vapors include heavy metals such as nickel, chromium, lead, manganese, and tin. In addition, some ingredients volatilization leads to toxic aldehydes formation such as formaldehyde, acetaldehyde, and acrolein. Smoking cigarettes is addictive and has been associated with many health issues such as heart disease, lung cancer, etc. Rising awareness of these dangers moves more people towards these electronic delivery systems, reducing the health effects of cigarettes. The toxicity of EC’s ingredients is well studied when ingested;however, their toxicity through inhalation remains unclear. Consequently, the use of ECs has become a significant concern worldwide and raises whether it is indeed safe to use. This paper will serve as a literature review paper to discuss the toxicity of commonly found ingredients in ECs and their associated health issues. Our conclusion emphasizes that even though smoking EC is less risker than smoking traditional cigarettes, it is still not safe due to the potentially harmful effect these E-cig’s ingredients have on the human’s health. In addition, E-cigarette’s aerosol could also contain toxic compounds such as formaldehyde, acetaldehyde, and acrolein due to glycerin’s thermo-degradation.

The Impact of Tobacco Taxation Policy on Slim Cigarette Use and the Growing Popularity of Slim Cigarettes in China Since 2014

Introduction: In 2016, China became the largest market for slim cigarettes in the world, selling 68.945 billion sticks. The purpose of this study is to examine the impact of China’s 2015 tobacco taxation policy on slim cigarette consumption and the product’s market trends. Methods: Monthly data on the market share of slim cigarettes and their average price between January 2014 and June 2017 were used to show tobacco market trends and to estimate the impact of the 2015 tobacco tax increase on tobacco consumption. Segmented regression analysis was used to estimate the immediate effect of the 2015 tax policy and the time trends in consumption due to the policy change. Findings: After the tobacco tax increase was announced in May 2015, the market share of slim cigarettes initially decreased by 0.2117 (p = 0.067). However, by the third month after the policy change, consumption began to increase, and the market share of slim cigarettes was 1.6 times the normal increase over time. Slim cigarettes gained a 2.02% additional share by the second quarter of 2017 (from 2.58% to 4.60%), controlling for the price difference between slim cigarettes and regular cigarettes. The coefficient of the share and the price ratio (slim cigarettes/regular cigarettes) was ?0.7536 (p = 0.0044), suggesting that slim cigarettes are a substitute for regular cigarettes. Estimates also show that after the tax increase was implemented, consumption of slim cigarettes increased almost three times the normal consumption rate (0.0069 versus 0.0024). Conclusion: The slim cigarette industry in China has grown rapidly in recent years. The 2015 tax increase has had only minimal or short-term impact on reducing the growing popularity of slim cigarettes. Since slim cigarettes are a substitute for regular cigarettes, more empirical research is urgently needed to study the health impacts of slim cigarette use and the impact of tobacco control policies on slim cigarette consumption.

Electronic cigarettes — myocardial infarction, hemodynamic compromise during pregnancy, and systolic and diastolic dysfunction: Minireview

The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.

On the Development and Maintenance of Cigarettes Exported to North Korea

According to the requirements of " going out" strategy of Jilin Tobacco Industry Co. Ltd.,in order to further expand the Changbaishan series brand in the market of North Korea,this paper elaborates the product development and maintenance ideas and measures for three cigarette companies in North Korea based on the actual work being done,so as to determine the development and maintenance focus of export cigarettes and provide strong technical support for accelerating the pace of localization of production while achieving homogenization of production.

Use of Cigarettes and Other Tobacco Products among Primary and Secondary School Students in Khartoum State, Sudan

Introduction: In Sudan, tobacco use is common;it is used in some form by 20% of the population. As most users start during adolescence, we aimed to determine the prevalence of ever use of tobacco products (i.e. cigarettes, herbal cigarettes, shisha and tombak) among Sudanese adolescent males and females, and to assess associations between tobacco ever use and personal characteristics. Methods: This cross-sectional study was conducted in Khartoum State, Sudan. The study data were collected in June 2014. The target population consisted of adolescents in 8th grade of primary education or 1st and 2nd grade of secondary education. They were asked to fill in a written questionnaire during the school break. Schools were randomly selected using a stratified two-stage cluster sampling design method. Results: A total of 1229 respondents (56.4% male), with a mean age of 14.5 years, were included in the analysis. Prevalence of cigarettes, herbal cigarettes, shisha and tombak ever use were 13%, 7.8% 5.9% and 3.5%, respectively. Older respondents were significantly more likely to have ever smoked cigarettes. Males were found to be significantly more likely to have ever used any tobacco products. Urban adolescents were significantly more likely to have ever used shisha. Respondents were in the bottom third percentiles with regard to academic achievements, had an almost three-fold increased risk of having ever smoked a cigarette and were at least five-fold more likely to have ever smoked herbal cigarettes. Moreover, respondents in the middle third percentiles were more than twice as likely to have ever smoked herbal cigarettes. Conclusion: As uptake of tobacco products increased significantly with age among males with a middle and lower school performance living in urban areas, timely prevention targeting adolescents, such as school-based tobacco control programmes, are recommended. Our findings show that prevention should start in primary school.

Assessment of tobacco heating system 2.4 on osteogenic differentiation of mesenchymal stem cells and primary human osteoblasts compared to conventional cigarettes

BACKGROUND Cigarette smoking(CS)is the most common method of consuming tobacco.Deleterious effects on bone integrity,increased incidence of fractures,and delayed fracture healing are all associated with CS.Over 150 of the 6500 molecular species contained in cigarette smoke and identified as toxic compounds are inhaled by CS and,via the bloodstream,reach the skeletal system.New technologies designed to develop a reduced-risk alternative for smokers are based on electronic nicotine delivery systems,such as e-cigarettes and tobacco heating systems(THS).THS are designed to heat tobacco instead of burning it,thereby reducing the levels of harmful toxic compounds released.AIM To examine the effects of THS on osteoprogenitor cell viability and function compared to conventional CS.METHODS Human immortalized mesenchymal stem cells(n=3)and primary human preosteoblasts isolated from cancellous bone samples from BG Unfall Klinik Tübingen(n=5)were osteogenically differentiated in vitro with aqueous extracts generated from either the THS 2.4“IQOS”or conventional“Marlboro”cigarettes for up to 21 d.Cell viability was analyzed using resazurin conversion assay(mitochondrial activity)and calcein-AM staining(esterase activity).Osteogenic differentiation and bone cell function were evaluated using alkaline phosphatase(AP)activity,while matrix formation was analyzed through alizarin red staining.Primary cilia structure was examined by acetylatedα-tubulin immunofluorescent staining.Free radical production was evaluated with 2’,7’-dichlorofluoresceindiacetate assay.RESULTS Our data clearly show that THS is significantly less toxic to bone cells than CS when analyzed by mitochondrial and esterase activity(P<0.001).No significant differences in cytotoxicity between the diverse flavors of THS were observed.Harmful effects from THS on bone cell function were observed only at very high,non-physiological concentrations.In contrast,extracts from conventional cigarettes significantly reduced the AP activity(by two-fold)and matrix mineralization(four-fold)at low concentrations.Additionally,morphologic analysis of primary cilia revealed no significant changes in the length of the organelle involved in osteogenesis of osteoprogenitor cells,nor in the number of ciliated cells following THS treatment.Assessment of free radical production demonstrated that THS induced significantly less oxidative stress than conventional CS in osteoprogenitor cells.CONCLUSIONTHS was significantly less harmful to osteoprogenitor cells during osteogenesisthan conventional CS. Additional studies are required to confirm whether THS isa better alternative for smokers to improve delays in bone healing followingfracture.

A Comparative Study of Non-Volatile Compounds Present in 3R4F Cigarettes and iQOS Heatsticks Utilizing GC-MS

It is now widely suggested that people who are dependent on nicotine should switch from ordinary tobacco smoking to alternative products, which at least reduce the overall harm from smoking. A number of alternatives are now popular, including electronic cigarettes and heatsticks. In this work comparative analysis of the smoke/aerosol emission from 3R4F standard cigarettes and iQOS heatsticks was undertaken. For this, gas chromatography-mass spectrometry (GC-MS) analysis was applied, to measure the non-volatile compounds of smoke/aerosol emission from individual samples, with the specific aim to determine their content of nicotine and selected other main components. All measurement data were collected under the Health Canada Intense (HCI) puffing regime. The most relevant findings of the present investigation can be summarized as follows. First, the number of measured aerosol components in the iQOS samples, with respect to those of 3R4F samples, was significantly lower (notably 37 versus 12 components). Second, the analysis of the iQOS and 3R4F GC-MS chromatographic fingerprints indicated a non-nicotine global component reduction (number and areas excluding nicotine) of larger than 80% for the iQOS samples in comparison to 3R4F samples. Third, the nicotine content of the iQOS aerosol was less than half that contained in the 3R4F smoke. The results from the present investigation indicate that—except for nicotine—smokers are exposed to a largely reduced number and amount of non-volatile, non-nicotine components in the iQOS heatstick aerosol, in comparison to those in the 3R4F cigarette smoke.

Experimental Study on a New Type of Drug-treated Cigarettes Lowering Bronchopulmonary Lesions

A new type of drug-treated cigarettes aimed at low-ering bronchopulmonary lesions have been studied. Therats smoking ordinary cigarettes were compared with therats smoking cigarettes treated with Chinese traditionaldrugs which possessed anti-inflammatory and detoxicationeffects. The results showed that bronchiolar and bronchi-olopulmonary lesions are less in the drug-treated groupby histopathologic observation. We also found that bacte-riophagocytosis and immunocytochemical lysozyme reac-tions of alveolar macrophages in bronchial alveolar lavagefluids from the drug-treated cigarette smoking rats wereweakened. There are some differences of surface ultra-structures of alveolar macrophages between the ordinarysmoking group and the drug-treated smoking group. Thisindicated differentially functional states of these alveo-lar macrophages in the different groups.

Smoking Cessation with E-Cigarettes in Smokers with a Documented History of Depression and Recurring Relapses

The association between nicotine dependence and affective disorders, particularly major depressive disorder (MDD), is well known with high prevalence rates being reported for smokers. The reason for this association is not clear, but, it has been argued that smoking may help individuals to cope with stress or medicate depressed mood. Smoking cessation programs are useful in helping smokers to quit, but smoking is a very difficult addiction to break, especially for people suffering from depression, and the need for novel and effective approaches to smoking cessation interventions for this special population is unquestionable. The e-cigarette is a battery-powered electronic nicotine delivery device (ENDD), which may help smokers to remain abstinent during their quit attempt. Here, we report for the first time objective measures of smoking cessation in two heavy smokers, suffering from depression, who experimented the e-cigarette.

Arsenic species in electronic cigarettes:Determination and potential health risk

Human exposure to contaminants from electronic cigarettes(e-cigarettes)and the associated health effects are poorly understood.There has been no report on the speciation of arsenic in e-liquid(solution used for e-cigarettes)and aerosols.We report here determination of arsenic species in e-liquids and aerosols generated from vaping the e-liquid.Seventeen e-liquid samples of major brands,purchased from local and online stores in Canada and China,were analyzed for arsenic species using high-performance liquid chromatography and inductively coupled plasma mass spectrometry.Aerosols condensed from vaping the eliquids were also analyzed and compared for arsenic species.Six arsenic species were detected,including inorganic arsenate(iAsⅤ),arsenite(iAsⅢ),monomethylarsonic acid(MMA),and three new arsenic species not reported previously.In e-liquids,iAsⅢwas detected in 59%,iAsⅤin 94%,and MMA in 47%of the samples.In the condensate of aerosols from vaping the e-liquids,iAsⅢwas detected in 100%,iAsv in 88%,and MMA in 13%of the samples.Inorganic arsenic species were predominant in e-liquids and aerosols of e-cigarettes.The concentration of iAsⅢin the condensate of aerosols(median 3.27μg/kg)was significantly higher than that in the e-liquid(median 1.08μg/kg)samples.The concentration of inorganic arsenic in the vaping air was approximately 3.4μg/m3,which approaches to the permissible exposure limit(10μg/m3)set by the United States Occupational Safety and Health Administration(OSHA).According to the Environmental Protection Agency’s unit risk factor(4.3×10-3 perμg/m3)for inhalation exposure to inorganic arsenic in the air,the estimated excess lung cancer risk from lifetime exposure to inorganic arsenic in the ecigarette vaping air(3.4μg/m3),assuming e-cigarette vaping at 1%of the time,is as high as1.5×10-4.These results raise health concerns over the exposure to arsenic from electronic cigarettes.

Inhibition of the NF-κB Signaling Pathway Improves Cigarette Mainstream Smoke-Induced Lung Injury and Gut Microbiota Disturbance

Currently,cigarette smoke(CS)remains a major contributor to disease morbidity and mortality.CS can be divided into cigarette mainstream smoke(CMS)and side-stream smoke,depending on where it is produced by burning tobacco^([1]).CMS is inhaled by smokers from the filter end during cigarette combustion and is strongly associated with the development of several diseases^([2-4]).

Is there a correlation between the changes in airway inflammation and the changes in respiratory mechanics after vaping in patients with asthma?

BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.

Burns resulting from spontaneous combustion of electronic cigarettes: a case series

Background:Electronic cigarette(e-cigarette)sales have grown rapidly in recent years,coinciding with a public perception that they are a safer alternative to traditional cigarettes.However,there have been numerous media reports of fires associated with e-cigarette spontaneous combustion.Case Presentation:Three severe burns caused by spontaneous combustion of e-cigarettes within a 6-month period were treated at the Santa Clara Valley Medical Center Burn Unit.Patients sustained partial and full-thickness burns.Two required hospitalization and surgical treatment.Conclusions:E-cigarettes are dangerous devices and have the potential to cause significant burns.Consumers and the general public should be made aware of these life-threatening devices.

Reanalysis of Cigarettes Confirms Increased Addictive Nicotine

吸烟对人健康的危害不言而喻,"戒烟"也早已成为关注公众健康的各国政府努力的方向。然而面对席卷全球的戒烟浪潮的烟草商们却在悄悄采取策略以保障他们的收益:他们增加每根香烟中尼古丁的含量,刻意延长人们吸一支烟的时间,或是增加吸烟时吞吐烟雾的次数。烟草商的目的只有一个,即千方百计诱使人们对香烟更加上瘾!针对这种现象,人们不得不呼吁司法层面的监控。

Medical Association:‘Safe’Cigarettes Don't Exist

刚刚收到裴小江的来稿,就收到了胡盼盼的邮件。两文大唱对台戏！本文见11月9日的Yahoo！短文文笔之犀利,有一股凛然正气！对Vector公司推出“微害”香烟之说,本文评论道:The research on which these claims are made isall done by an industry(that)is notorious for lying。本文的另一句话发人深省: cigarettes and cigarette smoke contain more than 4,000 chemicals that are harmful,so reducing a few won’t have much of an effect。我们不知道这种牌子为Omni的所谓“微害”香烟是否会飘洋过海来到中国,希望读者警惕。】

Ten Reasons to Kick Cigarettes

作为U.S.Sees Drop In Smoking By Pregnant Women的姊妹篇,我们选中了本篇。本文标题也有别致处,Kick用在口语中有“戒绝(恶习)”的意思。作者把它移植到书面语中,让人眼睛一亮！国人有“饭后一支烟,赛过活神仙”之戏说,殊不知,列于吸烟十大罪状之首的竟是:Smoking has been linked to depression.美国人有“吸烟减肥”之戏说,本文也加以否定。吸烟还能引起男女生理和智力上的不少非良性变化,这种变化甚至会祸及子孙。美国加州已开始在酒吧禁烟。感受最深的是bartender(酒吧招待): More than three-quarters of bartenders who complained of smoking-relatedrespiratory symptoms prior to the smoking ban reported that the symptoms hadresolved within one to two months after the ban went into effect(生效). 这似乎可用作“被动吸烟”的祸害的注脚。

Electronic cigarettes and toxic substances,including arsenic species

Electronic cigarettes,or e-cigarettes,are battery-powered devices that heat a liquid and deliver an aerosolized product to the user via inhalation.Electronic cigarettes are also popularly called"e-cigs","vapes","e-hookahs","mods",and"tank systems".A large variety of e-cigarettes are commercially available.Some e-cigarettes look like regular cigarettes,cigars,or pipes while others look like USB drives,pens,and popular everyday items.

E-Cigarettes:Smoky Signals

As China's new e-cigarette ban takes effect,a lack of detailed regulations threaten the multibillion-dollar industry's transition,Flavored e-cigarettes that attract young vape fans with fruit or candy-like flavors are disappearing from the Chinese market after new administrative measures on e-cigarettes published by the State Tobacco Monopoly Administration(STMA)went into effect on May 1.

Association between NNAL and Mortality in U.S. Adults, NHANES 2007-2014 with 2015 Mortality Follow-Up

Cigarette smoking is a leading cause of premature mortality, attributable to chronic exposure to toxic compounds in cigarette smoke, including tobacco-specific nitrosamines, which are known carcinogens. This research aims to assess the association between NNAL, a metabolite of the tobacco-specific nitrosamine NNK, and mortality. Data from 14,766 U.S. adults aged 21 - 79 in the National Health and Nutrition Examination Survey (2007-2014) included smoking status and urinary NNAL concentration at the time of examination. These data were linked to participants’ subsequent mortality status as recorded in the public-use Linked Mortality File (through 2015). Cox proportional hazards regression models assessed the relative risk of all-cause, cancer, cardiovascular disease (CVD), and other-causes mortality for increasing levels of natural log (creatinine-adjusted NNAL). In the whole sample, a unit increase in log (NNAL) is associated with a 20% higher risk of all-cause (HR = 1.20;95% CI: 1.16 - 1.24), cancer (HR = 1.20;95% CI: 1.14 - 1.26), CVD (HR = 1.21;95% CI: 1.12 - 1.31) and other-causes (HR = 1.20;95% CI: 1.15 - 1.25) mortality. Among current smokers, a unit increase in log (NNAL) is associated with 44% higher cancer mortality risk (HR = 1.44;95% CI: 1.08 - 1.92) and a 96% higher CVD mortality risk (HR = 1.96;95% CI: 1.20 - 3.20). Risks of all-cause and other-causes mortality, but neither cancer nor CVD mortality, were positively associated with NNAL among never and former smokers. Inferences are limited by the observational nature of the data, and by the focus on a single biomarker of tobacco-related exposure. The findings suggest that urinary NNAL concentration is acting as a proxy for exposure to the toxicants in cigarette smoke rather than as a biomarker of disease-specific mortality risk.