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Short-Term Cardiovascular Effects of E-Cigarettes: Influence of Device Power (TCORS-1)

Primary Purpose

Cardiovascular Risk Factor, Nicotine Dependence

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Electronic Cigarette
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Cardiovascular Risk Factor focused on measuring E-Cigarettes, Vaping, E-Cig Mods

Eligibility Criteria

21 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Use e-cigarettes on at least 25 days in the past 30 for at least 3 months and have not used another tobacco product in the past 30 days
  • Healthy on the basis of medical history and limited physical examination (screening visit), as described below:
  • Heart rate < 105 beats per minute (BPM)*
  • Systolic Blood Pressure < 160 and > 90*
  • Diastolic Blood Pressure < 100 and > 50*
  • Body Mass Index (BMI) ≤ 38.0 (at investigator's discretion for higher BMI if no other concurrent health issues)

    *Considered out of range if both machine and manual readings are above/below these thresholds.

  • Any race/ethnicity

Exclusion Criteria:

  • Used tobacco products other than e-cigarettes in past 30 days
  • Expired carbon monoxide of over 5 ppm at screening
  • The following unstable medical conditions:
  • Heart disease
  • Uncontrolled hypertension
  • Thyroid disease (not hypo or hyper, controlled with medication)
  • Diabetes
  • Hepatitis B or C or Liver disease
  • Glaucoma
  • Prostatic hypertrophy
  • Psychiatric conditions:
  • Current or past schizophrenia, and/or current or past bipolar disorder
  • Adult onset attention deficit hyperactivity disorder (ADHD) (if being treated)
  • Participants with current or past depression and/or anxiety disorders will be reviewed by the study physician and considered for inclusion
  • Psychiatric hospitalizations are not exclusionary, but study participation will be determined as per study physician's approval
  • Drug/Alcohol Dependence:
  • Alcohol or illicit drug dependence within the past 12 months with the exception of those who have recently completed an alcohol/drug treatment program
  • Positive toxicology test at the screening visit (THC & prescribed medications okay)
  • Opioid replacement therapy
  • Positive urine cannabis is not exclusionary but participant must report use of cannabis in any form on not more than 2 times per week to be eligible
  • Psychiatric medications:
  • Current regular use of any psychiatric medications with the exception of Selective Serotonin Reuptake Inhibitor (SSRI) and serotonin-norepinephrine reuptake Inhibitor (SNRIs) and current evaluation by the study physician that the participant is otherwise healthy, stable, and able to participate.
  • Medications
  • Use of medications that are inducers of nicotine metabolizing enzyme CYP2A6 (Example: rifampicin, dexamethasone, phenobarbital, and other anticonvulsant drugs).
  • Concurrent use of nicotine-containing medications
  • Other/Misc. Chronic Health Conditions
  • Oral thrush
  • Fainting
  • Untreated thyroid disease
  • Other "life threatening illnesses" as per study physician's discretion
  • Pregnancy
  • Pregnancy (self-reported and urine pregnancy test)
  • Breastfeeding (determined by self-report)
  • Concurrent participation in another clinical trial
  • Inability to communicate in English
  • Planning to quit smoking or vaping within the next 60 days

Sites / Locations

  • Zuckerberg San Francisco General Hospital
  • University of California, San Francisco

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Other

Other

Other

Arm Label

Power level 10, 15, or 20 watts

1 of the other 2 remaining power levels

Remaining power level

Arm Description

Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of 3 assigned battery power levels

Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of the other 2 remaining power levels

Using an electronic cigarette, the patient will participate in a standardized vaping session using the remaining power level

Outcomes

Primary Outcome Measures

Nicotine Exposure
Concentration of plasma nicotine (ng/ml) will be used to assess differences across the three power levels.
Subjective Effects: Withdrawal
We will compile a score for the subjective effect of withdrawal using the sum of points scored on the Minnesota Nicotine Withdrawal Scale (MNWS), where a higher score (score range from 0 points to 60 points) indicates a higher intensity of the indicated subjective effect.
Subjective Effects: Craving
We will compile a score for the subjective effect of craving using the sum of points scored in the two subscales (intention and desire to engage in smoking behavior that is anticipated as pleasant, and anticipation of relief from negative affect through smoking) of the Questionnaire of Smoking Urges (QSU-Brief), where a higher score (score range from 10 points to 70 points) indicates a higher intensity of the indicated subjective effect.
Subjective Effects: Reward
We will compile a score for the subjective effect of reward using the sum of points scored in the five subscales (Smoking Satisfaction - score range from 1 point to 7 points; Psychological Reward - score range from 5 points to 35 points; Aversion - score range from 2 points to 14 points; Enjoyment of Respiratory Tract Sensations - score range from 2 points to 14 points; and Craving Reduction - score range from 1 point to 7 points) of the modified Cigarette Evaluation Scale (mCES), where a higher score indicates a higher intensity of the indicated subjective effect.
Volatile Organic Compounds (VOC) Exposure
We will examine differences in 24-hour urine mercapturic acid metabolites of VOCs, particularly 3HPMA, the metabolite of acrolein across power settings
Cardiovascular Effects: Heart Rate
Participant heart rate will be measured in beats per minute throughout the inpatient stay.
Cardiovascular Effects: Blood Pressure
Participant systolic and diastolic blood pressure will be taken for 24 hours during ad-lib e-cigarette use.
Cardiovascular Effects: Epinephrine Excretion
Assays will be performed on participant urine samples to measure the presence of epinephrine metabolites in the form of catecholamines, in ng/ml.
Cardiovascular Effects: Biomarkers of Oxidative Stress
Assays will be performed on participant urine samples to measure oxidative stress-related constituents F2-isoprostane and 11-dTXB2 in ng/ml.
Cardiovascular Effects: Biomarkers of Inflammation
Assays will be performed on participant blood samples to measure cardiovascular inflammation-related constituents Interleukin 6 (IL-6), Vascular endothelial growth factor (VEGF), and Soluble intercellular adhesion molecule-1 (sICAM-1) in ng/ml.

Secondary Outcome Measures

Vaping Topography: Puff Number
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as puffs per minute.
Vaping Topography: Puff Duration
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds per puff.
Vaping Topography: Inter-Puff Interval
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds/minutes between puffs.

Full Information

First Posted
January 24, 2019
Last Updated
February 22, 2022
Sponsor
University of California, San Francisco
Collaborators
National Institutes of Health (NIH), Food and Drug Administration (FDA), National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03839745
Brief Title
Short-Term Cardiovascular Effects of E-Cigarettes: Influence of Device Power
Acronym
TCORS-1
Official Title
Short-Term Cardiovascular Effects of E-Cigarettes: Influence of Device Power
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Completed
Study Start Date
March 26, 2019 (Actual)
Primary Completion Date
December 31, 2021 (Actual)
Study Completion Date
December 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of California, San Francisco
Collaborators
National Institutes of Health (NIH), Food and Drug Administration (FDA), National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This study will examine the short-term cardiovascular (CV) effects of e-cigarette device power in a randomized, crossover clinical and behavioral pharmacology study of experienced adult e-cigarette users (N=21). The specific aim is to determine the impact of e-cigarette power on nicotine pharmacology, systemic exposure to toxic volatile organic compounds (VOCs), and short-term cardiovascular effects.
Detailed Description
This is a single-site, randomized, crossover study of experienced adult e-cigarette users to assess nicotine exposure, toxicant exposure, and the short-term CV effects of e-cigarette power. Three power levels will be assessed on all participants: 10, 15, and 20 watts. Hypothesis 1a: Systemic nicotine exposure and subjective measures of sensation in the throat, reward, and satisfaction will increase with increasing power in the e-cigarette device. Hypothesis 1b: Mercapturic acid metabolites of volatile organic compounds (VOCs), particularly acrolein, will increase with e-cigarette power. Hypothesis 1c: CV effects increase with higher power, and are manifested as changes in hemodynamic parameters, hormonal release, and biomarkers of endothelial function, platelet activation, inflammation, and oxidative stress.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cardiovascular Risk Factor, Nicotine Dependence
Keywords
E-Cigarettes, Vaping, E-Cig Mods

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Power level 10, 15, or 20 watts
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of 3 assigned battery power levels
Arm Title
1 of the other 2 remaining power levels
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using 1 of the other 2 remaining power levels
Arm Title
Remaining power level
Arm Type
Other
Arm Description
Using an electronic cigarette, the patient will participate in a standardized vaping session using the remaining power level
Intervention Type
Other
Intervention Name(s)
Electronic Cigarette
Intervention Description
E-cigarette Device: The delivery device will be a variable wattage all-in-one device with operating wattage of 7.0 - 75.0 W, which is inclusive of the three power levels we intend to study.
Primary Outcome Measure Information:
Title
Nicotine Exposure
Description
Concentration of plasma nicotine (ng/ml) will be used to assess differences across the three power levels.
Time Frame
Day 1 of each Arm
Title
Subjective Effects: Withdrawal
Description
We will compile a score for the subjective effect of withdrawal using the sum of points scored on the Minnesota Nicotine Withdrawal Scale (MNWS), where a higher score (score range from 0 points to 60 points) indicates a higher intensity of the indicated subjective effect.
Time Frame
Days 1-2 of each Arm
Title
Subjective Effects: Craving
Description
We will compile a score for the subjective effect of craving using the sum of points scored in the two subscales (intention and desire to engage in smoking behavior that is anticipated as pleasant, and anticipation of relief from negative affect through smoking) of the Questionnaire of Smoking Urges (QSU-Brief), where a higher score (score range from 10 points to 70 points) indicates a higher intensity of the indicated subjective effect.
Time Frame
Days 1-2 of each Arm
Title
Subjective Effects: Reward
Description
We will compile a score for the subjective effect of reward using the sum of points scored in the five subscales (Smoking Satisfaction - score range from 1 point to 7 points; Psychological Reward - score range from 5 points to 35 points; Aversion - score range from 2 points to 14 points; Enjoyment of Respiratory Tract Sensations - score range from 2 points to 14 points; and Craving Reduction - score range from 1 point to 7 points) of the modified Cigarette Evaluation Scale (mCES), where a higher score indicates a higher intensity of the indicated subjective effect.
Time Frame
Days 1-2 of each Arm
Title
Volatile Organic Compounds (VOC) Exposure
Description
We will examine differences in 24-hour urine mercapturic acid metabolites of VOCs, particularly 3HPMA, the metabolite of acrolein across power settings
Time Frame
Day 2 of each Arm
Title
Cardiovascular Effects: Heart Rate
Description
Participant heart rate will be measured in beats per minute throughout the inpatient stay.
Time Frame
Days 1-3 of each Arm
Title
Cardiovascular Effects: Blood Pressure
Description
Participant systolic and diastolic blood pressure will be taken for 24 hours during ad-lib e-cigarette use.
Time Frame
Day 2 of each Arm
Title
Cardiovascular Effects: Epinephrine Excretion
Description
Assays will be performed on participant urine samples to measure the presence of epinephrine metabolites in the form of catecholamines, in ng/ml.
Time Frame
Days 1-2 of each Arm
Title
Cardiovascular Effects: Biomarkers of Oxidative Stress
Description
Assays will be performed on participant urine samples to measure oxidative stress-related constituents F2-isoprostane and 11-dTXB2 in ng/ml.
Time Frame
Days 1-2 of each Arm
Title
Cardiovascular Effects: Biomarkers of Inflammation
Description
Assays will be performed on participant blood samples to measure cardiovascular inflammation-related constituents Interleukin 6 (IL-6), Vascular endothelial growth factor (VEGF), and Soluble intercellular adhesion molecule-1 (sICAM-1) in ng/ml.
Time Frame
Day 1-2 of each Arm
Secondary Outcome Measure Information:
Title
Vaping Topography: Puff Number
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as puffs per minute.
Time Frame
Day 1 of each Arm
Title
Vaping Topography: Puff Duration
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds per puff.
Time Frame
Day 1 of each Arm
Title
Vaping Topography: Inter-Puff Interval
Description
Vaping topography measures will be obtained from frame by frame analysis of high definition videos during the ad libitum sessions and measured as seconds/minutes between puffs.
Time Frame
Day 1 of each Arm

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Use e-cigarettes on at least 25 days in the past 30 for at least 3 months and have not used another tobacco product in the past 30 days Healthy on the basis of medical history and limited physical examination (screening visit), as described below: Heart rate < 105 beats per minute (BPM)* Systolic Blood Pressure < 160 and > 90* Diastolic Blood Pressure < 100 and > 50* Body Mass Index (BMI) ≤ 38.0 (at investigator's discretion for higher BMI if no other concurrent health issues) *Considered out of range if both machine and manual readings are above/below these thresholds. Any race/ethnicity Exclusion Criteria: Used tobacco products other than e-cigarettes in past 30 days Expired carbon monoxide of over 5 ppm at screening The following unstable medical conditions: Heart disease Uncontrolled hypertension Thyroid disease (not hypo or hyper, controlled with medication) Diabetes Hepatitis B or C or Liver disease Glaucoma Prostatic hypertrophy Psychiatric conditions: Current or past schizophrenia, and/or current or past bipolar disorder Adult onset attention deficit hyperactivity disorder (ADHD) (if being treated) Participants with current or past depression and/or anxiety disorders will be reviewed by the study physician and considered for inclusion Psychiatric hospitalizations are not exclusionary, but study participation will be determined as per study physician's approval Drug/Alcohol Dependence: Alcohol or illicit drug dependence within the past 12 months with the exception of those who have recently completed an alcohol/drug treatment program Positive toxicology test at the screening visit (THC & prescribed medications okay) Opioid replacement therapy Positive urine cannabis is not exclusionary but participant must report use of cannabis in any form on not more than 2 times per week to be eligible Psychiatric medications: Current regular use of any psychiatric medications with the exception of Selective Serotonin Reuptake Inhibitor (SSRI) and serotonin-norepinephrine reuptake Inhibitor (SNRIs) and current evaluation by the study physician that the participant is otherwise healthy, stable, and able to participate. Medications Use of medications that are inducers of nicotine metabolizing enzyme CYP2A6 (Example: rifampicin, dexamethasone, phenobarbital, and other anticonvulsant drugs). Concurrent use of nicotine-containing medications Other/Misc. Chronic Health Conditions Oral thrush Fainting Untreated thyroid disease Other "life threatening illnesses" as per study physician's discretion Pregnancy Pregnancy (self-reported and urine pregnancy test) Breastfeeding (determined by self-report) Concurrent participation in another clinical trial Inability to communicate in English Planning to quit smoking or vaping within the next 60 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gideon St. Helen, PhD
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
Zuckerberg San Francisco General Hospital
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Short-Term Cardiovascular Effects of E-Cigarettes: Influence of Device Power

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