Elevated Cellular Oxidative Stress in Circulating Immune Cells in Otherwise Healthy Young People Who Use Electronic Cigarettes in a Cross-Sectional Single-Center Study: Implications for Future Cardiovascular Risk

J Am Heart Assoc. 2020 Sep 15;9(18):e016983. doi: 10.1161/JAHA.120.016983. Epub 2020 Sep 8.


Background Tobacco cigarettes (TCs) increase oxidative stress and inflammation, both instigators of atherosclerotic cardiac disease. It is unknown if electronic cigarettes (ECs) also increase immune cell oxidative stress. We hypothesized an ordered, "dose-response" relationship, with tobacco-product type as "dose" (lowest in nonsmokers, intermediate in EC vapers, and highest in TC smokers), and the "response" being cellular oxidative stress (COS) in immune cell subtypes, in otherwise, healthy young people. Methods and Results Using flow cytometry and fluorescent probes, COS was determined in immune cell subtypes in 33 otherwise healthy young people: nonsmokers (n=12), EC vapers (n=12), and TC smokers (n=9). Study groups had similar baseline characteristics, including age, sex, race, and education level. A dose-response increase in proinflammatory monocytes and lymphocytes, and their COS content among the 3 study groups was found: lowest in nonsmokers, intermediate in EC vapers, and highest in TC smokers. These findings were most striking in CD14dimCD16+ and CD14++CD16+ proinflammatory monocytes and were reproduced with 2 independent fluorescent probes of COS. Conclusions These findings portend the development of premature cardiovascular disease in otherwise healthy young people who chronically vape ECs. On the other hand, that the COS is lower in EC vapers compared with TC smokers warrants additional investigation to determine if switching to ECs may form part of a harm-reduction strategy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03823885.

Keywords: electronic cigarettes; monocytes; nicotine; reactive oxidative species; tobacco cigarettes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology*
  • Cotinine / blood
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems
  • Female
  • Flow Cytometry
  • Humans
  • Killer Cells, Natural / chemistry
  • Killer Cells, Natural / drug effects
  • Leukocytes / chemistry*
  • Leukocytes / drug effects
  • Lymphocytes / chemistry
  • Lymphocytes / drug effects
  • Male
  • Middle Aged
  • Monocytes / chemistry
  • Monocytes / drug effects
  • Neutrophils / chemistry
  • Neutrophils / drug effects
  • Oxidative Stress*
  • Reactive Oxygen Species / blood
  • Risk Factors
  • Vaping / adverse effects*
  • Vaping / blood
  • Young Adult


  • Reactive Oxygen Species
  • Cotinine

Associated data

  • ClinicalTrials.gov/NCT03823885