- FAMRI Center
First evidence that e-cig use increases heart attacks, independent of the effect of smoking cigarettes
Every time I have posted a comment on a new study showing that e-cigarettes adversely affect blood vessels and blood in ways that increase risk of a heart attack, a friend and colleague who remains part of the (shrinking) collection of e-cigarette enthusiasts emails me and with he comment that, “if they are so bad where’s the evidence that e-cigarettes increase the risk of a heart attack?”
The first evidence just appeared.
Using the National Health Interview Survey (NIHS), a large national survey done in the US, Nardos Temesgen and colleagues at George Washington University, found that the odds of a heart attack increased by 42% among people who used e-cigarettes.
This increase in risk was on top of the increases in risk due to any smoking that the e-cigarette users were doing. This is a particularly important finding because most e-cigarette users are dual users who keep on smoking at the same time that they use e-cigarettes. What this means is that dual use of e-cigarettes with cigarettes is substantially more dangerous than smoking alone.
The assumption of most people – including me – has been that e-cigarette use would not add much risk to cigarettes. That is not the case. E-cigarette use increases the risk of a heart attack about as much as having diabetes.
The work also controlled for a wide range of confounding variables. In addition, the risks associated with other factors (like smoking, diabetes, and high blood pressure) in this study were similar to those established in earlier work. This fact strengthens the conclusions that e-cigarettes represent an independent cause of heart attacks.
The abstract of the study, “A cross sectional study reveals an association between electronic cigarette use and myocardial infarction,” is available here.
Here is the abstract:
Background: E-cigarettes (E-cigarettes) have grown in popularity as an alternative to traditional cigarettes especially among consumers who want to reduce the risk of morbidity and mortality associated with smoking. Nonetheless, a recent study showed both E-cigarettes and traditional cigarettes cause an increase in oxidative stress and endothelial dysfunction, however this effect is less pronounced with E-cigarettes. Currently, there is a limited study that shows the impact of E-cigarette in the cardiovascular system. Therefore, data from the 2014 National Health Interview Survey (NHIS) was used to evaluate the effect of E-cigarettes on the cardiovascular system, specifically the effect on myocardial infarction (MI).
Methods: Analysis of the 2014 National Health Interview Survey (NHIS) database was performed to examine the effect of E-cigarettes on MI. Initially, subjects were assigned to one of two groups: those with a history of MI and those without a history of MI. The t-test and chi-square test were subsequently applied to compare the different demographics and health characteristics between these two groups. A logistic regression model was then used to measure the association between E-cigarettes and history of MI. Data was adjusted for multiple risk factors for MI including age, gender, race, body mass index, income, the status of smoking cigarettes, and history of hypertension, diabetes, and hypercholesterolemia.
Results: A total of 35,156 subjects were included in the final logistic model. This model showed that increasing age (OR, 1.04; p <0.001), history of hypertension (OR, 2.72; p < 0.001), high cholesterol (OR, 2.19; p< 0.001), and diabetes (OR, 1.68; p< 0.001) are associated with increased odds of myocardial infarction. With respect to smoking, increased frequency of smoking was associated with increasingly higher odds of MI when compared to patients who had never smoked: every day smokers (OR, 2.75 p<0.001), some day smokers (OR, 2.39; p<0.001), and former smokers (OR 1.80; p<0.001.) In contrast, females (OR, 0.49; p<0.001), Hispanics (OR, 0.62; p<0.001), and people with higher incomes (OR, 0.93 [95% CI, 0.90-0.96]; p<0.001) have lower odds of heart attack. With respect to Electronic cigarette use and MI, analysis revealed an odds ratio of 1.42 with p = 0.017.
Conclusions: Our findings indicate that Electronic cigarette use, when adjusted for other risk factors, is associated with a 42 % increased odds of myocardial infarction. This increase in odds is consistent regardless of traditional cigarette smoking history. More studies are needed to further assess this risk.