Cerebrovascular disease and e-cigarettes use in adolescents and young adults: A critical concern for health professionals
Keywords:
cerebrovascular disease, e-cigarette, adolescent, young adult, health professionalsAbstract
Cerebrovascular disease is a leading cause of mortality and vascular complications in the brain, significantly impacting public health systems worldwide, with a high number of patients and deaths per year. Smoking is a major risk factor in the development of the disease. Currently, electronic cigarettes (e-cigarettes) are gaining popularity among young people worldwide because of the misunderstanding that e-cigarettes are harmless. The liquid in e-cigarettes contains nicotine and many other harmful chemicals, such as aldehyde produced from vaporizing the liquid, which damages blood vessel walls, promotes atherosclerosis, affects the cardiovascular and neurological systems, and increases the risk of Cerebrovascular disease. This article reviews the effects of e-cigarettes on Cerebrovascular disease incidence in adolescents and young adults. This age groups exhibits the highest rate of e-cigarettes smoking and belief that they are safer than conventional cigarettes, alongside the insufficient regulations of e-cigarettes. Therefore, it is a challenge for health professionals to prevent stroke caused by e-cigarettes and reduce the use of e-cigarettes in adolescents and young adults by using evidence-based knowledge to provide health education to the public, particularly among adolescents and young adults. This includes developing guidelines for campaigns to prevent, reduce, and quit e-cigarettes use, monitoring social and public health impacts, and developing future research.
References
Feigin VL, Brainin M, Norrving B, et al. World stroke organization: Global stroke fact sheet 2025. Int J Stroke 2025;20(2):132-44. doi:10.1177/17474930241308142.
GBD 2021 stroke risk factor collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: A systematic analysis for the global burden of disease study 2021. Lancet Neurol 2024;23(10):973-1003. doi:10.1016/S1474-4422(24)00369-7.
Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: A report of us and global data from the american heart association. Circulation 2024;149(8):e347-913. doi:10.1161/CIR.000000000 0001209.
Department of disease control. Academic information about e-cigarettes. [Internet]. 2024 [cited 2025 Jan 19]. Available from: https://ddc.moph.go.th/uploads/publish/1589020240719032342.pdf. (in Thai)
Thanawat T. Impacts in all dimensions from e-cigarettes using, review of programming guidelines for raising awareness of the health hazards and prevention of vaping among teenagers. Thai J Public Health Sci 2024;7(2):93-106. (in Thai)
Gordon T, Karey E, Rebuli ME, et al. E-cigarette toxicology. Annu Rev Pharmacol Toxicol 2022;62:301-22. doi:10.1146/annurev-pharmtox-042921-084202.
Ndunda PM, Muutu TM. Electronic cigarette use is associated with a higher risk of stroke. Stroke 2019; 50(Suppl_1):A9. doi:10.1161/str.50.suppl_1.9.
Patel U, Patel N, Khurana M, et al. Effect comparison of e-cigarette and traditional smoking and association with stroke-a cross-sectional study of NHANES. Neurol Int 2022;14(2):441-52. doi:10.3390/neurolint 14020037.
Siegel J, Patel SH, Mankaliye B, et al. Impact of electronic cigarette vaping on cerebral ischemia: What we know so far. Transl Stroke Res 2022;13(6):923-38. doi:10.1007/s12975-022-01011-w.
Panthong W, Saiyot R. Factors associated with cerebrovascular disease in patients with diabetes and hypertension at Srinarong hospital. Reg Health Promot Cent J 2024;18(1):193–208. (in Thai)
Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol 2020;75(15):1804-18. doi:10.1016/j.jacc.2019.12.072.
Neurological institute of Thailand. Clinical nursing practice guideline for stroke. 5th ed. Bangkok: Thana Press Co.,Ltd; March 2024. ISBN: 978-616-8322-68-0. (in Thai)
Chuamworakul W. Vascular risk factors for recurrent stroke in Nonsung hospital. J Environ Community Health 2024;9(2):527-34. (in Thai)
McCaughey CJ, Murphy G, Jones J, et al. Safety and efficacy of e-cigarettes in those with atherosclerotic disease: a review. Open Heart 2023;10(2):e002341. doi:10.1136/openhrt-2023-002341.
Rosungnoen R, Satianpoonsook T, Seesensui S, et al. Guidelines for changing dissolution smoking behavior. J Nakhon Ratchasima Coll 2021;15(2):362-76. (in Thai)
Department of Disease Control. The tobacco product control act B.E. 2560. [Internet]. 2017 [cited 2025 Jan 22]. Available from: https://ddc.moph.go.th/otpc/journal_detail.php?publish=11754. (in Thai)
St Helen G, Nardone N, Addo N, et al. Differences in nicotine intake and effects from electronic and combustible cigarettes among dual users. Addiction 2020;115(4):757-67. doi:10.1111/add.14884.
Janik M, Ufnalska B, Rychlewska-Duda J, et al. Systematic review: E-cigarettes vs. conventional cigarettes. J Educ Health Sport 2025;78:57621. doi:10.12775/JEHS.2025.78.57621.
World Health Organization. The statement on electronic cigarettes [Internet]. Bangkok: World Health Organization Thailand; 2021 [cited 2024 Dec 3]. Available from: https://cdn.who.int/ media/docs/ default-source/thailand/ncds/who-thailand-statement-on-electronic-cigarettes-as-of-20-october-2021-(th).pdf?sfvrsn =56366162_5. (in Thai)
Marques P, Piqueras L, Sanz MJ. An updated overview of e-cigarette impact on human health. Respir Res 2021;22(1):151. doi:10.1186/s12931-021-01737-5.
World Health Organization. Electronic cigarettes (e-cigarettes) [Internet]. 2024 [cited 2024 Dec 1]. Available from: https://www.who.int/publications/i/item/WPR-2024-DHP-001.
Gholap VV, Kosmider L, Golshahi L, et al. Nicotine forms: why and how do they matter in nicotine delivery from electronic cigarettes?. Expert Opin Drug Deliv 2020;17(12):1727-36.
Shi J, Xiong L, Guo J, et al. The association between combustible/electronic cigarette use and stroke based on national health and nutrition examination survey. BMC Public Health 2023;23(1):697. doi:10.1186/ s12889-023-15371-x.
Belok SH, Parikh R, Bernardo J, et al. E-cigarette, or vaping, product use-associated lung injury: A review. Pneumonia (Nathan) 2020;12:12. doi:10.1186/s41479-020-00075-2.
Mikheev VB, Brinkman MC, Granville CA, et al. Real-time measurement of electronic cigarette aerosol size distribution and metals content analysis. Nicotine Tob Res 2016;18(9):1895-902. doi:10.1093/ntr/ntw128.
Herman M, Tarran R. E-cigarettes, nicotine, the lung and the brain: Multi-level cascading pathophysiology. J Physiol 2020;598(22):5063-5071. doi:10.1113/JP278388.
Tobacco control research and knowledge management center. TRC research update. Electronic cigarettes, a disaster that hunts Thai children. [Internet]. 2024 [cited 2024 Dec 2]. Available from: https:// www.trc.or.th/th/attachments/article/905/TRCRUupdate16Vol2.pdf. (in Thai)
Centers for disease control and prevention. E-cigarette use among youth. [Internet]. 2024 Oct [cited 2025 Jan 22]. Available from: https://www.cdc.gov/tobacco/e-cigarettes/youth.html.
Chachvarat T, Phawong V, Nunta S. Teenagers health behaviors. JNHR 2018;19(3):107-20. (in Thai)
Addjanagitti P, Pongboriboon U. Prevention of smoking in adolescents. EAU Heritage Sci 2021;15(2):42-8. (in Thai)
Ruanphet K, Theerasut S, Suttipun N, et al. Health literacy to reduce health risk behaviors among adolescents in the municipality Buriram province. Reg Health Promot Cent 9 J 2024;18(2):550-62. (in Thai)
Kasemsuk K, Boonbunjob U. Health promotion of early adulthood development: nurses’ important role. Royal Thai Air Force Med Gaz 2018;64(3):14–61. (in Thai)
Jornburom Y, Chaiyasung P, Yakasem P, et al. Nurse's role in enhancing adolescents' perceptions of the dangers of electronic cigarettes. Thai J Nurs. 2021;70(1):52-60. (in Thai)
The committee for preparation of the Thai health report. E-cigarette. [Internet]. 2024 Sep [cited 2024 Dec 3]. Available from: https://www.thaihealthreport.com/th/articles_detail.php?id=139. (in Thai)
Senadisai S, Klampakorn S. Teaching and learning management for controlling tobacco consumption: fundamental nursing course. 2nd ed. Nonthaburi: Publishing of Suetawan company limited; 2020.
Centers for disease control and prevention. Health effects of e-cigarettes. [Internet]. 2024 May 15 [cited 2025 Jan 19]. Available from: https://www.cdc.gov/tobacco/e-cigarettes/health-effects.html.
Ali N, Xavier J, Engur M, et al. The impact of e-cigarette exposure on different organ systems: a review of recent evidence and future perspectives. J Hazard Mater 2023;457:131828. doi:10.1016/j.jhazmat. 2023.131828.
Parekh T, Pemmasani S, Desai R. Risk of stroke with e-cigarette and combustible cigarette use in young adults. Am J Prev Med 2020;58(3):446-52. doi:10.1016/j.amepre.2019.10.008.
Siddiqi TJ, Rashid AM, Siddiqi AK, et al. Association of electronic cigarette exposure on cardiovascular health: a systematic review and meta-analysis. Curr Probl Cardiol 2023;48(9):101748. doi:10.1016/j.cpcardiol. 2023.101748.
Jessri M, Sultan AS, Magdy E, et al. Nicotine e-vaping and cardiovascular consequences: A case series and literature review. Eur Heart J Case Rep 2020;4(6):1-7. doi:10.1093/ehjcr/ytaa330.
Podzolkov VI, Bragina AE, Druzhinina NA, et al. E-cigarette smoking (vaping) and markers of vascular wall damage in young subjects without cardiovascular disease. Ration Pharmacother Cardiol 2021;17(4):521-7. doi:10.20996/1819-6446-2021-08-04.
Potter TBH, Tannous J, Vahidy FS. A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke. Curr Atheroscler Rep 2022;24(12):939-48. doi:10.1007/s11883-022-01067-x.
Kuntic M, Oelze M, Steven S, et al. Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: Evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2). Eur Heart J 2020;41(26):2472-83. doi:10.1093/eurheartj/ehz772.
Cardenas HL, Evanoff NG, Fandl HK, et al. Endothelial-derived extracellular vesicles associated with electronic cigarette use impair cerebral microvascular cell function. J Appl Physiol (1985) 2023;135(2):271-8. doi:10.1152/japplphysiol.00243.2023.
Mancuso S, Bhalerao A, Cucullo L. Use of conventional cigarette smoking and e-cigarette vaping for experimental stroke studies in mice. Methods Mol Biol 2023;2616:441-51. doi:10.1007/978-1-0716-2926-0_31.
Palacheewa N, Thangkratok P. Digital technology: Innovation for smoking prevention among children and adolescents in the twenty-first century. Thai J Cardio-Thoracic Nurs 2019;30(2):15-25. (in Thai)
Ruanphet K, Bonkhunthod P, Saengngam T, et al. Nurse’s role in prevention and cessation of electronic cigarette smoking in adolescents. Reg Health Promot Cent 9 J 2021;15(38):619-31. doi:10.14456/rhpc9j.2021.44. (in Thai)
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