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E-cig advocates now arguing about what “risk” means.  Konstantinos Farsalinos and Raymond Niaura just published a letter to the editor in American Journal of Preventive Medicine criticizing our paper linking e-cigarette use with heart attacks on the grounds that we used the term “risk factor” to describe the cross-sectional association between e-cig use and having had a heart attack.

As we point out in our response, the term “risk factor” was specifically developed to describe associations found in cross-sectional studies.  (Wikipedia has a nice explanation of this point.)  We also noted that the association we found in the population is precisely what would be expected based on the known biological and clinical effects of e-cigarette use on the cardiovascular system.

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