Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Effects of Involuntary Smoking and Vaping on the Cardiovascular System

Version 1 : Received: 2 April 2019 / Approved: 3 April 2019 / Online: 3 April 2019 (10:07:13 CEST)

How to cite: Neuberger, M. Effects of Involuntary Smoking and Vaping on the Cardiovascular System. Preprints 2019, 2019040037. Neuberger, M. Effects of Involuntary Smoking and Vaping on the Cardiovascular System. Preprints 2019, 2019040037.


In deaths and diseases attributed to tobacco smoke cardiovascular events exceed cancer and respiratory diseases. Second hand smoke (SHS) promotes the development of arteriosclerosis and can also trigger acute changes of endothelial function and of blood coagulability. Indoor smoking bans reduced coronary syndrome and myocardial infarction 10-20% within one year and were followed by sustainable decreases of stroke and diabetes. With a smoke-free hospitality industry people recognized tobacco smoke as an air pollutant, smoking in public was denormalized and social acceptance of smoking in front of children and pregnant women decreased also in homes and in cars. Combined effects with ambient air pollution are proven for active smoking and suspected for SHS. Contamination with third hand smoke (THS, “cold smoke”) persists for months in homes and cars, creating secondary pollutants that in some cases are more toxic (e.g., tobacco-specific nitrosamines). Remnants found in air, dust, and on surfaces (carpets, wallpapers, upholstery, soft toys) were associated with their metabolites in saliva and urine of children and with elevated levels of nicotine on hands and cotinine in urine of nonsmokers residing in homes previously occupied by smokers. In animal experiments effects of THS were found on thrombogenesis, insulin resistance through oxidative stress, on the developing immune system, lipid metabolism and alterations in liver, lung, skin and behavior. Much less is known about health effects for bystanders from the aerosols exhaled during “vaping” of e-cigarettes, but nicotine and other toxins from e-cigarettes are certainly a hazard, which should be prevented by the use of dermal and oral nicotine products, which are safer for nicotine replacement and without risk for bystanders.


second-hand smoke; cardiovascular disease; third-hand smoke; passive vaping; electronic cigarettes; heated tobacco; water pipe; myocardial infarction; stroke; diabetes


Medicine and Pharmacology, Cardiac and Cardiovascular Systems

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