Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

Background Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID) DERR1-10.2196/29084

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Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews (Preprint)

10.2196/preprints.29084 ◽

2021 ◽

Author(s):

Renee O'Leary ◽

Maria Ahmed Qureshi ◽

Giusy Rita Maria La Rosa ◽

Robin W M Vernooij ◽

Damian Chukwu Odimegwu ◽

...

Keyword(s):

Health Effects ◽

Systematic Reviews ◽

Cardiovascular Health ◽

Cardiovascular Effects ◽

White Paper ◽

Assessment Tools ◽

Evidence Based ◽

Narrative Synthesis ◽

Potential Benefits ◽

Based Medicine

BACKGROUND Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. OBJECTIVE We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. METHODS These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. RESULTS The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. CONCLUSIONS The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. CLINICALTRIAL PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29084

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Respiratory and Cardiovascular Health Effects of E-Cigarette Substitution: Protocol for Two Living Systematic Reviews

10.1101/2021.03.18.21253876 ◽

2021 ◽

Author(s):

Renee O'Leary ◽

Maria Qureshi ◽

Guisy Rita Maria La Rosa ◽

Robin W. M. Vernooij ◽

Damian Chukwu Odimegwu ◽

...

Keyword(s):

Health Effects ◽

Systematic Reviews ◽

Cardiovascular Health ◽

Cardiovascular Effects ◽

White Paper ◽

Assessment Tools ◽

Peer Review Journal ◽

Potential Benefits ◽

Based Medicine ◽

Country Specific

Background: Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, respiratory and cardiovascular effects in particular, have come to differing conclusions. Objective: The purpose of our two systematic reviews is to critically assess and synthesize the available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal is to promote the health literacy of ENDS users with facts on the health effects of ENDS. A secondary goal is to develop policy briefs to provide governmental bodies with a preliminary assessment of the potential public health impacts of ENDS. Methods: These two reviews will be living systematic reviews. The systematic reviews will be initiated with a baseline review. Studies will be evaluated with the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned due to the heterogeneity of data. A search for recently published studies will be conducted every three months, and an updated review published every six months for the duration of the project or possibly longer. Results: The baseline and updated reviews will be published in a peer review journal. The review findings will be reported in a white paper for clinicians, a fact sheet for people who use ENDS, and country-specific policy briefs. Conclusions: The substitution of ENDS for cigarettes is one of the ways to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research.

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Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results

Canadian Medical Association Journal ◽

10.1503/cmaj.1031920 ◽

2005 ◽

Vol 172 (5) ◽

pp. 661-665 ◽

Cited By ~ 91

Author(s):

R. Hatala

Keyword(s):

Systematic Reviews ◽

Evidence Based Medicine ◽

Evidence Based ◽

Based Medicine

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Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽

10.1093/neuros/nyaa027 ◽

2020 ◽

Vol 87 (3) ◽

pp. 435-441 ◽

Cited By ~ 2

Author(s):

Victor M Lu ◽

Christopher S Graffeo ◽

Avital Perry ◽

Michael J Link ◽

Fredric B Meyer ◽

...

Keyword(s):

Systematic Reviews ◽

Evidence Based Medicine ◽

Lessons Learned ◽

Evidence Based ◽

Cranial Neuralgia ◽

The Individual ◽

Meta Analyses ◽

Based Medicine ◽

Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

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Cardiovascular effects of air pollution

Clinical Science ◽

10.1042/cs20070444 ◽

2008 ◽

Vol 115 (6) ◽

pp. 175-187 ◽

Cited By ~ 381

Author(s):

Robert D. Brook

Keyword(s):

Air Pollution ◽

Cardiovascular Diseases ◽

Health Effects ◽

Cardiovascular Health ◽

Cardiovascular Effects ◽

Systemic Circulation ◽

Pollution Source ◽

Global Public Health ◽

Particle Exposure

Air pollution is a heterogeneous mixture of gases, liquids and PM (particulate matter). In the modern urban world, PM is principally derived from fossil fuel combustion with individual constituents varying in size from a few nanometres to 10 μm in diameter. In addition to the ambient concentration, the pollution source and chemical composition may play roles in determining the biological toxicity and subsequent health effects. Nevertheless, studies from across the world have consistently shown that both short- and long-term exposures to PM are associated with a host of cardiovascular diseases, including myocardial ischaemia and infarctions, heart failure, arrhythmias, strokes and increased cardiovascular mortality. Evidence from cellular/toxicological experiments, controlled animal and human exposures and human panel studies have demonstrated several mechanisms by which particle exposure may both trigger acute events as well as prompt the chronic development of cardiovascular diseases. PM inhaled into the pulmonary tree may instigate remote cardiovascular health effects via three general pathways: instigation of systemic inflammation and/or oxidative stress, alterations in autonomic balance, and potentially by direct actions upon the vasculature of particle constituents capable of reaching the systemic circulation. In turn, these responses have been shown to trigger acute arterial vasoconstriction, endothelial dysfunction, arrhythmias and pro-coagulant/thrombotic actions. Finally, long-term exposure has been shown to enhance the chronic genesis of atherosclerosis. Although the risk to one individual at any single time point is small, given the prodigious number of people continuously exposed, PM air pollution imparts a tremendous burden to the global public health, ranking it as the 13th leading cause of morality (approx. 800000 annual deaths).

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