Rising trend of E-cigarettes among adolescents of Pakistan and cardiovascular implications of electronic nicotine delivery systems

Table 1 Biochemistry to measures of prevention

Section	Key points
Biochemistry of E-cigarettes	E-cigarette aerosols contain propylene glycol, vegetable glycerin, nicotine, and flavoring agents like menthol, ethyl vanillin
	Variability in device design affects vapor production
	Some toxicants present, but extent of human exposure still unclear compared to traditional smoking
Rising trends of E-cigarettes in Pakistan	Pakistan's vaping market is growing rapidly, expected to generate $77.2 million by 2024
	Liberal regulations and flavored options increase youth appeal
	Socioeconomic and marketing factors drive the trend
Socioeconomic issues leading to increased trends	Lower education levels linked to poor awareness of vaping risks
	Urbanization increases access to vape shops
	Social media glamorizes vaping
	These factors create a high-risk environment for youth
Cardiovascular implications: Mechanisms, biomarkers, and long-term consequences	Nicotine induces endothelial dysfunction, raises heart rate and blood pressure
	Aerosols contain formaldehyde, acetaldehyde causing oxidative stress
	Ultrafine particles may cause endothelial injury
	Chronic use leads to arterial stiffness, inflammation (elevated CRP, IL-6, TNF-α)
	Adolescents more vulnerable due to developing systems
	Dual use (e-cigarettes + traditional cigarettes) amplifies risks
Measures of prevention	E-cigarette use among youth should be illegal
	E-cigarettes must not be advertised as safe alternatives
	Stricter control of harmful aldehyde levels
	Device regulations to limit toxic emissions
	Awareness campaigns, school interventions, and counseling are needed
	Evidence-based public health strategies required

CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-alpha.