Vascular health after quitting smoking or switching to e-cigarette use: a systematic review of prospective studies with GRADE assessment.
Jacob George, Giusy Rita Maria La Rosa, Jacqueline Yu et al.
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In 30 seconds
This systematic review assessed prospective evidence on vascular function after smoking cessation or switching to exclusive e-cigarette use among adult smokers. It included 23 studies with 11 702 participants: 14 cohort studies, 5 quasi-experimental studies, and 4 randomized controlled trials. Across studies, cessation was consistently associated with improvements in pulse wave velocity, augmentation index, and flow-mediated dilation; some changes appeared within 1 month and were sustained up to 24 months. Evidence certainty was very low overall, except for moderate certainty in RCTs assessing flow-mediated dilation.
Key findings
- Smoking cessation was associated with improvements in pulse wave velocity, augmentation index, and flow-mediated dilation.
- Some vascular improvements were observed within 1 month and persisted up to 24 months.
- RCTs of e-cigarette switching reported significant flow-mediated dilation improvements irrespective of nicotine content.
- Evidence certainty was very low overall, with moderate certainty for flow-mediated dilation findings from RCTs.
Why it matters
Vascular function markers provide insight into endothelial health and arterial stiffness, and their improvement after cessation is consistent with the biological plausibility of cardiovascular benefit from sustained smoking abstinence. The review also suggests that vascular changes may occur relatively early, while the low or variable certainty means the magnitude and durability of benefit remain uncertain.
What to keep in mind
The evidence was synthesized qualitatively across varied study designs, and certainty was very low for most outcomes. Long-term effects remain uncertain.