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We sought to determine if acute EC compared to TC smoking had less harmful effects on arrhythmogenic risk factors including acute changes in hemodynamics, heart rate variability (HRV), and ventricular repolarization (VR). In PLWH who smoke, changes in hemodynamics, HRV, and VR were compared pre\/post acutely using an EC, TC, or puffing on an empty straw on different days in random order, in a crossover study. Thirty\u2010seven PLWH (36 males, mean age 40.5\u2009\u00b1\u20099.1\u2009years) participated. Plasma nicotine was greater after TC versus EC use (10.12\u2009\u00b1\u20090.96 vs. 6.18\u2009\u00b1\u20090.99\u2009ng\/mL, respectively, <jats:italic>p<\/jats:italic>\u2009=\u20090.004). HR increased significantly, and similarly, after acute EC and TC smoking compared to control. Changes in HRV that confer increased cardiac risk (LF\/HF ratio) were significantly smaller after acute EC versus TC use, consistent with a harm reduction effect. In a post\u2010hoc analysis of PLWH with and without positive concurrent recreational drug use as indicated by point of care urine toxicology testing, this differential effect was only seen in PLWH not currently using recreational drugs. Changes in VR were not different among the three exposures. In PLWH who smoke, EC compared to TC smoking resulted in smaller adverse changes in HRV. This differential effect was accompanied by a smaller increase in plasma nicotine, and was negated by concurrent recreational drug use. Additional studies are warranted in this vulnerable population disproportionately affected by tobacco\u2010related health disparities.<\/jats:p>","DOI":"10.14814\/phy2.16158","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T03:05:35Z","timestamp":1721790335000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Arrhythmogenic effects of acute electronic cigarette compared to tobacco cigarette smoking in people living with <scp>HIV<\/scp>"],"prefix":"10.14814","volume":"12","author":[{"given":"Isabelle","family":"Ruedisueli","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Gornbein","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Computational Medicine UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-8585","authenticated-orcid":false,"given":"Holly R.","family":"Middlekauff","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/anec.12362"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(03)00678-7"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2362.2001.00849.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.03.036"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00192.2020"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-474X.2005.00636.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2016.03.001"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.13393"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-33203-1"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.12.049"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2018.1489103"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.107678"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/02786826.2018.1500013"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.8"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.11.1239"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.304493"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.118737"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2013.07.004"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1067\/mmt.2000.110944"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0956462416632428"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000695"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2018.03.007"},{"key":"e_1_2_9_24_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.003411","article-title":"HIV and cardiovascular disease: We need a mechanism, and we need a plan","volume":"4","author":"Freiberg M. 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