Cardiac Autonomic Dysfunction and Increased Oxidative Stress in Conventional Cigarettes and E-Cigarettes: Heart Rate Variability as a Cardiovascular Predictor

Conventional and electronic cigarette (e-cig) users face an increased risk of cardiorespiratory diseases, driven by well-characterized pathways involving inflammation and oxidative stress (OS). Conventional cigarettes contain numerous harmful chemicals, such as nicotine and non-nicotine compounds, which produce reactive oxygen species. Although initially considered a safer alternative, the e-cig still generates toxic aldehydes that are capable of triggering oxidative responses. Heart rate variability (HRV) is an important tool for assessing autonomic function and predicting prognosis. Cardiac autonomic dysfunction, indicated by reduced HRV, has emerged as a critical cardiovascular risk factor associated with several diseases. Clinical and experimental studies show that increased OS is directly associated with heightened sympathetic activity and inversely with parasympathetic modulation. This review demonstrates that exposure to conventional cigarettes smoking and e-cigs adversely affects cardiac autonomic function, detectable by a global reduction in HRV that reflects a shift toward sympathetic dominance and a consequent increase in cardiovascular risk. These changes are associated with increased OS due to nicotine and non-nicotine compounds maintaining sympathovagal imbalance in smokers. Thus, we suggest that autonomic dysfunction, detected by HRV, correlates with oxidative responses and may be used as a modifiable risk factor in longitudinal studies involving both smoking modalities.