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April 03, 2023 5 min read

Since hitting the market, vaping has grown rapidly, showing significant upward trends in awareness and daily use [1].

Devices that use a heating element to aerosolize “e-liquids” into vapor for the user to inhale are known as 'Electronic Nicotine Delivery Systems' (ENDS for short), and they include products such as e-cigarettes, personal vaporizers, vape pens, and e-hookahs.  

In recent years, the percentage of adults who have tried ENDS has increased substantially.

In addition, the use of ENDS is even more prevalent in younger populations, to a point where it is now considered a major public health concern [2].

Although the toxicants of ENDS vapor are found in lower quantities compared with tobacco cigarette smoke [3], it does not mean vaping is safe or even less harmful. The vapor of ENDS can contain nicotine, volatile organic compounds, tobacco-specific nitrosamines, ultrafine particles, propylene glycol, vegetable glycerin, and metals, such as nickel, tin, and lead [4].

These chemicals are respiratory irritants that can cause inflammatory reactions, decreased exhaled nitric oxide levels (a test used to assess pulmonary inflammation), and respiratory flow resistance [5].

However, there is substantially variation of these toxicants depending on the product being utilized [4].

Although large cross-sectional surveys of adolescents show a potential association of ENDS use and respiratory symptoms, no studies have examined the relationship of ENDS use and physical fitness. Therefore, a recent study compared physical fitness levels among male soldiers using ENDS, tobacco cigarettes, or both, and those that have never used either [6].

Training and maintaining physical fitness are crucial within this population and among other groups such as emergency personnel, first responders, and athletes, so any exposure detrimental to physical fitness deserves considerable scrutiny. This is the first study to examine relationships between ENDS and physical fitness performance, making the results novel and useful to inform further investigation.

Implication of this vaping study

The primary findings of this study are that those who used both ENDS and cigarettes averaged slower 2-mile run times and fewer push-ups and sit-ups than those who didn’t use this products.

In addition, ENDS users demonstrated slower 2-mile run times and performed fewer push-ups than those that did not use ENDS [6].

Although ENDS users showed a decrease in performance, it is plausible that the shorter amount of exposure to ENDS (average =1.4 years) is not enough time to identify the true physical effects that are associated with vaping. If a cohort of ENDS users with longer exposure (e.g., 2-5 years) was investigated; it’s possible that physical fitness decrements would have been much greater.

Vaping and cardiovascular risk

Public awareness of the deleterious effects of tobacco smoke on health has led many people to turn to electronic cigarettes (e-cigarettes) in the hope that they offer a less harmful alternative to smoking. However, the relative safety or danger of e-cigarette use (vaping) is a matter of fierce scientific and regulatory debate. 

A growing body of literature indicates that e-cigarette use has adverse cardiovascular effects [7], but the mechanism of e-cigarette-induced cardiovascular toxicity is unclear.

Therefore, to answer the important question of whether chronic e-cigarette use carries vascular risks like those of cigarette smoke, a recent clinical observational study was conducted to investigate the association of chronic e-cigarette use and vascular impairment on the physiological and cellular levels [8].

Highlights of this study

Both chronic vapers and smokers have more impaired endothelial function than nonusers (demonstrated by lower brachial artery flow-mediated dilation). In addition, the serum of vapers and smokers had significantly reduced nitric oxide secretion by endothelial cells relative to nonusers’ serum.

Condensed e-cigarette aerosol did not directly reduce nitric oxide secretion, indicating that the serum’s inhibitory activity was produced in response to the inhalation rather than directly from the aerosol.

Vapers’ serum, but not smokers’ serum, caused more permeability than nonusers’ serum in microvascular endothelial cells.

Permeability is the ability of molecule to pass through a layer of cells to the other side. Too much cell permeability makes vessels leaky, which impairs function and increases the risk for cardiovascular disease.

Vapers and smokers exhibited changes in circulating levels of biomarkers of inflammation, cell adhesion, and thrombosis relative to nonusers, but the profiles of changes in these 2 cohorts differed considerably. Notably, vapers’ serum had higher concentrations of the RAGE (receptor for advanced glycation end products) than smoker serum and nonuser serum.

RAGE regulates immune responses and inflammation, so higher levels of RAGE positively correlate with other inflammatory markers.

Serum from chronic vapers does not contain elevated hydrogen peroxide, but incubation of cultured endothelial cells with the chronic vaper serum increases hydrogen peroxide levels.


This study demonstrated that blood from participants who used e-cigarettes and those who smoked caused a significantly greater decrease in nitric oxide production by the blood vessel cells than the blood of nonusers. Notably, the researchers found that blood from those who used e-cigarettes also caused more permeability in the blood vessel cells than the blood from both those who smoked cigarettes and nonusers.

Blood from those that used e-cigarettes also caused a greater release of hydrogen peroxide by the blood vessel cells than the blood of the nonusers. Consequently, each of these three factors can contribute to impairment of blood vessel function in people who use e-cigarettes.

The best advice is to protect your cardiovascular function as much as you possibly can.

The best way to do that is to exercise daily and abstain from smoking cigarettes and vaping. You can also add a proven supplement like CoQ10 to your daily routine.

CoQ10 is an important compound found in every cell in the body, and it has been proven time after time to improve heart health, energy production, and more.

1.    McMillen, R.C., et al., Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine Tob Res, 2015. 17(10): p. 1195-202.
2.    Walley, S.C., B.P. Jenssen, and C. Section on Tobacco, Electronic Nicotine Delivery Systems. Pediatrics, 2015. 136(5): p. 1018-26.
3.    Goniewicz, M.L., et al., Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control, 2014. 23(2): p. 133-9.
4.    Chun, L.F., et al., Pulmonary toxicity of e-cigarettes. Am J Physiol Lung Cell Mol Physiol, 2017. 313(2): p. L193-L206.
5.    McConnell, R., et al., Electronic Cigarette Use and Respiratory Symptoms in Adolescents. Am J Respir Crit Care Med, 2017. 195(8): p. 1043-1049.
6.    Dinkeloo, E., et al., Vaping, Smoking, and the Physical Fitness of Active Young Men. Am J Prev Med, 2020. 58(1): p. e31-e37.
7.    Fetterman, J.L., et al., Flavorings in Tobacco Products Induce Endothelial Cell Dysfunction. Arterioscler Thromb Vasc Biol, 2018. 38(7): p. 1607-1615.
8.    Mohammadi, L., et al., Chronic E-Cigarette Use Impairs Endothelial Function on the Physiological and Cellular Levels. Arterioscler Thromb Vasc Biol, 2022. 42(11): p. 1333-1350.

Dr. Paul Henning

About Dr. Paul

I'm currently an Army officer on active duty with over 15 years of experience and also run my own health and wellness business. The majority of my career in the military has focused on enhancing Warfighter health and performance. I am passionate about helping people enhance all aspects of their lives through health and wellness. Learn more about me