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E-cigarettes may be independently linked to erectile dysfunction, new research finds

Men between 20 and 65 years of age with no prior history of CVD but who use ENDS daily are more than twice (2.4 times) as likely as men who have never used ENDS to report erectile dysfunction.

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Smoking has long been associated with Erectile Dysfunction (ED) and Cardiovascular Disease (CVD). However, little research has explored if there is a similar association among men who use Electronic Nicotine Delivery Systems (ENDS), commonly referred to as e-cigarettes. In the first population-based study of its kind, researchers from NYU Grossman School of Medicine and Johns Hopkins University School of Medicine published a study online today in the American Journal of Preventive Medicine that suggests men between 20 and 65 years of age with no prior history of CVD but who use ENDS daily are more than twice (2.4 times) as likely as men who have never used ENDS to report erectile dysfunction.   

According to the researchers, since ENDS use seems to be associated with ED independent of age, CVD and other common ED risk factors, ENDS users should be informed about the possible link between ENDS use and experiencing ED—which impacts one in five men over the age of 20 in the United States.

“Given that many people use e-cigarettes as a form of smoking harm reduction or to help them with smoking cessation, we need to fully investigate the relationship between vaping products and erectile dysfunction, and potential implications for men’s sexual health. Our findings underscore the need to conduct further studies to contextualize the e-cigarette use pattern that is relatively safer than smoking,” said Omar El Shahawy, MD, PhD, MPH, assistant professor in the Department of Population Health at NYU Langone and lead author of the study. “Our analyses accounted for the cigarette smoking history of participants, including those who were never cigarette smokers to begin with, so it is possible that daily e-cigarette vaping may be associated with higher odds of erectile dysfunction regardless of one’s smoking history.”

The research team used data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study of 45,971 U.S. adults aged 18 years and older that examines various tobacco use behaviors and health outcomes.

This study was restricted to 13,711 males, 20 years and older, who responded to a question regarding ED. Dr. Tanmik Shah, NYU Langone, the lead statistician and study co-author, examined the association between ENDS and ED in the full sample, as well as in a restricted sample of 11,207 adult males aged 20 to 65 years with no prior CVD diagnosis, while adjusting for multiple risk factors. Respondents were classified as never, former and current (occasional or daily) users. Almost half of the participants were former cigarette smokers, 21 percent were current cigarette smokers, and 14 percent used other tobacco products.

Compared to those who never used ENDS, daily users were more than two times more likely to report having ED (2.2 times in the full sample and 2.4 times in the restricted sample). There was a significant association between ENDS use and ED among respondents aged 20 to 65 with normal Body Mass Index and without CVD, suggesting an association of ED with ENDS use among a relatively healthy population.

Within the restricted sample, 10.2 percent of respondents reported ED. Five and a half percent reported occasional ENDS use while 2.5 percent reported daily ENDS use. Compared to those who reported never using ENDS, current daily ENDS users were more likely to report ED in both the full and restricted samples. Physical activity was associated with lower odds of ED in both population samples.

In addition to El Shahawy, other NYU Langone researchers include Scott Sherman, MD; Tanmik Shah, MPH; Meghan Durr, MPH; Ria Pinjani, MPH. Researchers from the Johns Hopkins School of Medicine include Michael J. Blaha, MD, who is the senior author of this work; Olufunmilayo H. Obisesan, MD, MPH; Albert D. Osei, MD, MPH; Iftekhar Uddin, MD, MSPH and Mohammadhassan Mirbolouk, MD. Additional investigators include Emilia J. Benjamin, MD, Boston University School of Medicine; Andrew Stokes, PhD, Boston University School of Medicine, Tom Loney, PhD, Mohammed Bin Rashid University of Medicine and Health Sciences, UAE.

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Young vapers perform worse in exercise testing

On average, the group of young vapers had lower ‘peak exercise capacity’ (186 watts) than the group who did not vape or smoke (226 watts) but similar capacity to the group of smokers (182 watts). This is a measure of the maximum amount of physical exertion that a person can achieve.

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Young people who vape perform worse than non-vapers in tests designed to measure their capacity for exercise, according to a study presented at the European Respiratory Society (ERS) Congress in Vienna, Austria. The research also showed that the performance of young vapers was similar to that of young smokers.

The study adds to growing evidence that long-term use of vaping is harmful and challenges the idea that vaping could be a healthier alternative to smoking.

The research was presented by Dr Azmy Faisal, senior lecturer in cardiorespiratory physiology in the department of sport and exercise sciences at Manchester Metropolitan University, UK. He said: “Previous research has shown that vaping is linked to lung inflammation and damage, and harmful changes to the blood vessels. Although, some research suggests that vaping could be used to cut back or quit smoking, we don’t yet know what longer-term vaping use does to our bodies.”

The study included 60 people in their 20s who all had normal lung function according to spirometry testing. Twenty were non-smokers and non-vapers, 20 had been vaping for at least two years and 20 had been smoking for at least two years.

Each person took part in an incremental exercise test on a static bike. This is the gold-standard for testing physical ability and how well a person copes with exercise, looking at their heart, lungs, and muscles’ responses at harder and harder levels until they reach their maximum. They were also given blood tests and an ultrasound scan to analyse how well their arteries were functioning.

On average, the group of young vapers had lower ‘peak exercise capacity’ (186 watts) than the group who did not vape or smoke (226 watts) but similar capacity to the group of smokers (182 watts). This is a measure of the maximum amount of physical exertion that a person can achieve. At peak exercise, vapers and smokers were also less able to consume oxygen on average (2.7 litres per minute and 2.6 litres per minute) compared to the non-smoking non-vaping groups (3 litres per minute).

Both vapers and smokers showed signs that their blood vessels were not working as well as the non-smoking and non-vaping group, according to the blood tests and ultrasound scans. The smokers and the vapers were more out of breath, experienced intense leg fatigue and had higher levels of lactate in their blood, a sign of muscle fatigue, even before they reached their maximum level of exercise.

Dr Faisal said: “In this study, we looked at a group of young people with no apparent signs of lung damage. Among the people who had been vaping or smoking for at least two years, we saw important differences in how well they coped with exercise. The smokers and the vapers had measurably excess breathing while using the exercise bikes. They found it harder to breath, their muscles became more fatigued, and they were less fit overall. In this regard, our research indicated that vaping is no better than smoking.”

Dr Filippos Filippidis is Chair of the ERS Tobacco Control Committee, a reader in public health at Imperial College London and was not involved in the research. He said: “Vapes are being sold cheaply and in a variety of flavours to appeal to young people. As a result, we’re seeing more and more young people take up the habit without knowing what the long-term consequences could be to their health.

“Although it’s always a challenge to know if the associations we find in these studies are causal or a result of some other systematic differences between groups, people who vape need to be aware that using these products could make them less fit and able to take part in exercise. Doctors and policymakers also need to know about the risks of vaping, and we should be doing all we can to support children and young people to avoid or quit vaping.”

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Some adverse pregnancy outcomes may increase risk of heart disease later in life

A self-reported history of gestational hypertension was associated with cardiovascular disease. Women with preeclampsia or all three adverse pregnancy outcomes also had a numerically higher prevalence of heart disease, but it did not meet the standards of statistical significance. No association was found between gestational diabetes and heart disease.

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Pregnancy-related hypertension has already been proven to lead to a number of negative health outcomes later in life, including more bothersome menopause symptoms like hot flashes, the risk of dementia, kidney problems, and stroke. A new study suggests it can also lead to cardiovascular disease during menopause. Results of the study were presented at the 2024 Annual Meeting of The Menopause Society in Chicago, USA.

In the new study involving nearly 400 women with a mean age of 81.6 years, researchers sought to assess the association between a self-reported history of preeclampsia or eclampsia, gestational hypertension, and gestational diabetes with cardiovascular outcomes in postmenopausal women.

What they found is that a self-reported history of gestational hypertension was associated with cardiovascular disease. Women with preeclampsia or all three adverse pregnancy outcomes also had a numerically higher prevalence of heart disease, but it did not meet the standards of statistical significance. No association was found between gestational diabetes and heart disease.

“Future research based on a larger sample size is needed to better understand the role adverse pregnancy outcomes may have in cardiovascular disease development and risk stratification,” says Marie Tan, lead author from Drexel University College of Medicine in Philadelphia.

More detailed results will be discussed at the 2024 Annual Meeting of The Menopause Society as part of the presentation entitled “The association between adverse pregnancy outcomes and cardiovascular disease in menopausal women: results from a cross-sectional analysis.”

“Cardiovascular disease is the number one cause of mortality in women and it’s important to study any new risk factors” says Dr. Stephanie Faubion, medical director for The Menopause Society. “Although future research is still needed, studies like this are important and remind us to thoroughly discuss a patient’s health history, including any complications or adverse outcomes during pregnancy.”

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Babies born to women consuming a high fat, sugary diet at greater risk of cardiovascular disease and diabetes in later life

Consuming a high-fat, sugary diet during pregnancy also increases the likelihood of the unborn baby becoming insulin resistant in adulthood, potentially triggering diabetes and causing cardiovascular disease. This is despite babies being a normal weight at birth.

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Babies born to pregnant women with obesity are more likely to develop heart problems and diabetes as adults due to fetal damage caused by the high-fat, high-energy diet of their mother.

That’s the groundbreaking finding from a new study published in the Journal of Physiology that shows for the first time that maternal obesity alters a critical thyroid hormone in the fetal heart, disrupting its development.

Consuming a high-fat, sugary diet during pregnancy also increases the likelihood of the unborn baby becoming insulin resistant in adulthood, potentially triggering diabetes and causing cardiovascular disease. This is despite babies being a normal weight at birth.

University of South Australia researchers identified the link by analysing tissue samples from the fetuses of pregnant baboons fed a high-fat, high-energy diet in a biomedical research institute in the United States. They then compared this to fetuses from baboons on a control diet.

Lead author, University of South Australia PhD candidate Melanie Bertossa, says the findings are significant because they demonstrate a clear link between an unhealthy diet high in saturated fats and sugar, and poor cardiovascular health.

“There has been a long-standing debate as to whether high-fat diets induce a hyper- or hypothyroid state in the fetal heart. Our evidence points to the latter,” Bertossa says.

“We found that a maternal high-fat, high-energy diet reduced concentrations of the active thyroid hormone T3, which acts like a switch around late gestation, telling the fetal heart to start preparing for life after birth. Without this signal, the fetal heart develops differently.”

Bertossa says that diets high in fat and sugar can alter the molecular pathways involved in insulin signalling and critical proteins involved in glucose uptake in the fetal heart. This increases the risk of cardiac insulin resistance, often leading to diabetes in adulthood.

“You’re born with all the heart cells you will ever have. The heart doesn’t make enough new heart muscle cells after birth to repair any damage, so changes that negatively impact these cells before birth could persist for a lifetime.

“These permanent changes could cause a further decline in heart health once children reach adolescence and adulthood when the heart starts to age.”

Senior author, UniSA Professor of Physiology Janna Morrison, says the study demonstrates the importance of good maternal nutrition in the leadup to pregnancy, not only for the mother’s sake but also for the health of the baby.

“Poor cardiac outcomes were seen in babies that had a normal birth weight – a sign that should guide future clinical practice,” Prof Morrison says.

“Cardiometabolic health screening should be performed on all babies born from these types of pregnancies, not just those born too small or too large, with the goal being to detect heart disease risks earlier.”

Prof Morrison says that if rising rates of high-fat sugary diets are not addressed, more people will develop health complications such as diabetes and cardiovascular disease, which could result in shorter life spans in the decades ahead.

“Hopefully, with the knowledge we have now about the negative health impacts of obesity, there is potential to change this trajectory.”

The researchers are currently undertaking long-term studies of babies born to women on high- fat high-energy diets to track their health over decades.

Maternal high-fat high-energy diet alters metabolic factors in the non-human primate fetal heart” is published in the Journal of Physiology and authored by researchers from the University of South Australia, University of Wyoming and Texas Biomedical Health Institute.

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