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These differences indicate that dual product use, meaning smoking combustible cigarettes and also using e-cigarette products, may actually be worse for vascular health than either smoking or vaping alone." Both cigarette smoking and e-cigarette vaping are known to promote endothelial dysfunction, which is the inability of big blood arteries to open sufficiently to give enough blood to the heart and other tissues

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Obviously, it is challenging to obtain exact figures regarding the scale of an illegal activity

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