Atherosclerotic lower extremity peripheral artery disease (PAD) is increasingly recognized as an important cause of cardiovascular morbidity and mortality that affects >230 million people worldwide. Traditional cardiovascular risk factors, including advanced age, smoking, and diabetes, are strongly linked to an increase risk of PAD. Although PAD has been historically underappreciated compared with coronary artery disease and stroke, greater attention on PAD in recent years has led to important new epidemiological insights in the areas of thrombosis, inflammation, dyslipidemia, and microvascular disease. In addition, the concept of polyvascular disease, or clinically evident atherosclerosis in multiple arterial beds, is increasingly identified as a particularly malignant cardiovascular disease worthy of special clinical attention and further study. It is noteworthy that PAD may increase the risk of adverse outcomes in similar or even greater magnitude than coronary disease or stroke. In this review, we highlight important new advances in the epidemiology of PAD with a particular focus on polyvascular disease, emerging biomarkers, and differential risk pathways for PAD compared with other atherosclerotic diseases.

Epidemiology of Peripheral Artery Disease and Polyvascular Disease.

The use of electronic (e)-cigarettes was initially considered a beneficial solution to conventional cigarette smoking cessation. However, paradoxically, e-cigarette use is rapidly growing among nonsmokers, including youth and young adults. In 2019, this rapid growth resulted in an epidemic of hospitalizations and deaths of e-cigarette users (vapers) due to acute lung injury; this novel disease was termed e-cigarette or vaping use-associated lung injury (EVALI). Pathophysiologic mechanisms of EVALI likely involve cytotoxicity and neutrophilic inflammation caused by inhaled chemicals, but further details remain unknown. The undiscovered mechanisms of EVALI are a barrier to identifying biomarkers and developing therapeutics. Furthermore, adverse effects of e-cigarette use have been linked to chronic lung diseases and systemic effects on multiple organs. In this comprehensive review, we discuss the diverse spectrum of vaping exposures, epidemiological and clinical reports, and experimental findings to provide a better understanding of EVALI and the adverse health effects of chronic e-cigarette exposure. 

Vaping and Lung Inflammation and Injury

E-Cigarettes Reexamined: Product Toxicity.

Electronic cigarettes (e-cigarettes) and hookah smoking have gained tremendous popularity over the past decade. With the constantly evolving e-cigarette market and potential impact of the COVID-19 pandemic on users of these tobacco products, research is needed to assess the prevalence and safety of these devices as well as potential public health implications and cessation tools. For this year in review, PubMed was searched from January 2021–December 14, 2021, for articles related to e-cigarettes, vaping-related lung injury, and hookah smoking. Relevant articles addressing the objectives were included in this review. This review focused primarily on articles based on United States populations. Gray literature and nonpublished articles were not included in this review. The 2020 pandemic resulted in a decline in e-cigarette usage among youth (potentially due to the COVID-19 pandemic); however, recent research in 2021 suggests that e-cigarette usage is increasing again among youth. Conflicting evidence exists for e-cigarettes and the risk of COVID-19 infection, but biological plausibility suggests that e-cigarette users are more susceptible to COVID-19 infection and more severe COVID-19 infection compared to non–e-cigarette users. Hookah smoking has remained stable across the past several years and remains a primarily social activity among youth. New e-cigarette devices are constantly emerging, resulting in an increased demand to understand the safety of these devices. Additionally, hookah smoking continues to be a concerning public health issue with the increase in hookah bars and venues coupled with lack of policy regulations for hookah smoking

2021 Year in Review: E-Cigarettes, Hookah Use, and Vaping Lung Injuries During the COVID-19 Pandemic

https://escholarship.org/content/qt43v9k54m/qt43v9k54m.pdf?t=rdsob8

Training and Career Development in Cardio-Oncology Translational and Implementation Science.

Tobacco cigarette smoking is the most prevalent reversible risk factor for cardiovascular disease in the USA. Electronic cigarettes, invented as an alternative nicotine source for smokers unable or unwilling to stop smoking, have gained skyrocketing popularity, but their cardiovascular risk remains uncertain. Although data recently analysed in a Cochran report do support their superior effectiveness to other forms of nicotine replacement therapies for smoking cessation, electronic cigarettes are also frequently used by non-smokers-especially high school students. There are no long-term outcome studies on the cardiovascular risk of vaping electronic cigarettes, but the effects of electronic cigarettes on known risk factors for cardiovascular disease, including neurohumoural activation, oxidative stress and inflammation, endothelial function and thrombosis, have been studied. In this review, we summarise evidence in humans that supports the notion that while electronic cigarettes may be less harmful than traditional cigarettes, they are not harmless. Additionally, the increasing popularity of vaping marijuana with its unknown cardiovascular risks as well as the outbreak in 2019 of EVALI (electronic cigarette, or vaping, product use-associated lung injury) related to bootlegged vaping products raise further concerns. Before physicians can confidently advise their smoking patients about the role of electronic cigarettes as a means of smoking cessation to lower cardiovascular risk, improved regulation and quality control is necessary.

https://heart.bmj.com/content/heartjnl/early/2021/02/10/heartjnl-2020-318150.full.pdf

Vaping and cardiac disease

Author(s): Jackson, Samuel B; Tanoue, Michael; Shahandeh, Negeen; Lopez-Mattei, Juan; Brown, Sherry-Ann; Han, Janet K; Yang, Eric H

/pdf/cardioonc-are-we-reaching-across-the-digital-aisle-cfixoi0c5y.pdf

#Cardioonc: Are We Reaching Across the Digital Aisle?

http://www.jscai.org/article/S2772930322003283/pdf

Invasive Coronary Imaging Assessment for Cardiac Allograft Vasculopathy: State-of-the-art Review

A 54-year-old man with a history of atrial flutter presented with anterior ST-segment elevation myocardial infarction complicated by cardiogenic shock and underwent percutaneous coronary intervention of the left main coronary artery. He was placed on triple antithrombotic therapy and ultimately recovered. However, before discharge, he developed hypotension, confusion, and hemiplegia. (Level of Difficulty: Beginner.).

/pdf/a-cautionary-tale-of-triple-therapy-1ija9lfopn.pdf

Negeen Shahandeh

Papers

Vaping and cardiac disease

#Cardioonc: Are We Reaching Across the Digital Aisle?

Invasive Coronary Imaging Assessment for Cardiac Allograft Vasculopathy: State-of-the-art Review

A Cautionary Tale of Triple Therapy.

Apple watch detected ventricular tachycardia in a pregnant patient