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The American Academy of Pediatrics has linked high caffeine intake in adolescents to anxiety, irregular heart rhythms, and chronic sleep deprivation, which is an independent risk factor for cardiovascular disease Combined use compounds cardiovascular stress: When vaping and energy drink consumption overlap, as they frequently do, the cumulative stimulant load places added strain on the heart

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Prolonged exposure to nicotine, however, causes an increased number of binding sites, a process known as upregulation that is important in the craving and withdrawal effects seen in nicotine addiction