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What has been discovered to be difficult for EVALI analysis also applies to cardiovascular and different systemic effects of ECs, with the additional complexity that systemic effects depend upon uptake from the alveolae into the pulmonary capillaries. Model systems can’t absolutely characterize human biology and particularly in complicated situations such as cardiovascular diseases there are limitations of preclinical studies. The current data of cardiovascular effects of ECs has been recently summarized by Buchanan et al. in this journal10 and we would only point out three exemplars for example the direction of research in this area. First, while mannequin techniques might not fully represent human biology (especially in advanced circumstances similar to cardiovascular diseases), they do provide a possibility to study persistent exposures that can serve as a harbinger for humans. Second, human exposure studies are difficult to conduct due to moral constraints related to exposure to probably dangerous substances.
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