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*China National Tobacco Corporation is the worlds largest producer of cigarettes, but is not included in the Big 4, as it primarily serves the Chinese domestic market

However, this extra strain on the heart can lead to heart disease

Smoking-related catecholamine stimulation is associated with increased heart rate (HR), blood pressure (BP), and coronary vasoconstriction, which are risk factors for CVD 3

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66 Research Update The 2018 CPHA position statement provided a review of the available information concerning vaping to 2017, but noted that research was expanding rapidly