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Of all the included studies, only seven evaluated the effects of electronic cigarettes in a healthy non-tobacco smoking population, these studies revealed significant effects, including increases in heart rate, mean arterial blood pressure, arterial stiffness, and oxidative stress, as well as respiratory system changes such as alterations in the transcriptomes of the respiratory epithelium and alveolar macrophages, and a sudden increase in airflow resistance suggesting airway obstruction

Other biomarkers of biologic events with the potential to lead to harm are declines in alveolar neutrophil and macrophage counts and declines in neutrophil elastase 1-antiprotease complexes

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