PDF(Pubmed)
Abstract：
The leading cause of death in people living with HIV (PLWH) is cardiovascular disease, and the high prevalence of tobacco cigarette (TC) smoking is a major contributor. Switching to electronic cigarettes (ECs) has been promoted as a harm reduction strategy. We sought to determine if acute EC compared to TC smoking had less harmful effects on arrhythmogenic risk factors including acute changes in hemodynamics, heart rate variability (HRV), and ventricular repolarization (VR). In PLWH who smoke, changes in hemodynamics, HRV, and VR were compared pre/post acutely using an EC, TC, or puffing on an empty straw on different days in random order, in a crossover study. Thirty-seven PLWH (36 males, mean age 40.5 ± 9.1 years) participated. Plasma nicotine was greater after TC versus EC use (10.12 ± 0.96 vs. 6.18 ± 0.99 ng/mL, respectively, p = 0.004). HR increased significantly, and similarly, after acute EC and TC smoking compared to control. Changes in HRV that confer increased cardiac risk (LF/HF ratio) were significantly smaller after acute EC versus TC use, consistent with a harm reduction effect. In a post-hoc analysis of PLWH with and without positive concurrent recreational drug use as indicated by point of care urine toxicology testing, this differential effect was only seen in PLWH not currently using recreational drugs. Changes in VR were not different among the three exposures. In PLWH who smoke, EC compared to TC smoking resulted in smaller adverse changes in HRV. This differential effect was accompanied by a smaller increase in plasma nicotine, and was negated by concurrent recreational drug use. Additional studies are warranted in this vulnerable population disproportionately affected by tobacco-related health disparities.
摘要：
艾滋病毒感染者（PLWH）的主要死亡原因是心血管疾病，烟草香烟（TC）的高流行率是主要原因。改用电子烟（EC）已被推广为减少危害的策略。我们试图确定与TC吸烟相比，急性EC是否对致心律失常的危险因素（包括血流动力学的急性变化）的有害影响较小。心率变异性（HRV），和心室复极化（VR）。在PLWH谁抽烟，血液动力学的变化，HRV,和VR使用EC进行前后急性比较，TC,或者在不同的日子里以随机的顺序在空稻草上膨化，在交叉研究中。37PLWH（36男性，平均年龄40.5±9.1岁）。使用TC后血浆尼古丁高于EC（10.12±0.96vs.6.18±0.99ng/mL，分别,p=0.004)。HR显著增加,同样，与对照组相比，急性EC和TC吸烟后。急性EC与TC使用后，导致心脏风险增加的HRV变化（LF/HF比率）明显较小，符合减少伤害的效果。在对PLWH的事后分析中，有或没有积极的并发娱乐性药物使用，如护理点尿液毒理学测试所示，这种差异效应仅见于目前未使用消遣性药物的PLWH.VR的变化在三种曝光中没有差异。在PLWH谁抽烟，与TC吸烟相比，EC导致HRV的不良变化较小。这种差异效应伴随着血浆尼古丁的较小增加，并因同时使用娱乐性药物而被否定。有必要在受烟草相关健康差异影响过大的脆弱人群中进行更多研究。
