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A recent systematic review with GRADE assessment found that smoking cessation and, in more limited evidence, switching to exclusive e-cigarette use were associated with early improvements in pulse wave velocity, augmentation index, and flow-mediated dilation, changes that are biologically compatible with improved arterial compliance and reduced vascular tone, and thus may contribute to lower blood pressure, although overall certainty was low (moderate only for RCT evidence on flow-mediated dilation) [25]

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Specifically, acute exposure to nicotine-containing ENDS vapor results in mucus accumulation, overproduction of multiple cytokines, deposition of ECM, and fibrosis ( Figure 8 )

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