March 9, 2019

Stanton A. Glantz, PhD

Fourth paper links ecigs to heart attacks and stroke

On March 18, 2019, Mohinder R. Vindhyal and colleages will be presenting Impact on Cardiovascular Outcomes Among E-Cigarette Users: A Review From National Health Interview Surveys at the American College of Cardiology meeting.  This study adds to the growing literature (other papers: 1, 2, 3) that people who use e-cigarettes are at increased risk of cardiovascular disease, including heart attacks and strokes.  They also, for the first time, found an association with circulatory problems.

Beyond showing that e-cigarettes are a lot more dangerous than people used to think (and Public Health England still maintains), this growing literature raises serious issues about the claims that e-cigarettes are a good “alternative” to cigarettes, i.e., useful devices for smoking cessation.  Leaving aside the fact that for most smokers e-cigarettes make it harder, not easier, to quit smoking, it is important to consider the risk/benefit balance for e-cigs for those people who do manage to quit smoking with them. 

In particular, in the recent randomized controlled trial that showed that e-cigs combined with intensive counselling as part of a formal smoking cessation program outperformed NRT, the authors found that 80% of former smokers were still using e-cigarettes a year later compared to just 9% of NRT users.  If these people continue using e-cigs and doing so increases risk of heart attacks, stroke, and other diseases, those risks might outweigh the benefits of more cessation.

Of course, most smokers who use e-cigs continue to be dual users (i.e., continue using both products at the same time), which is substantially more dangerous than using either product alone (evidence: 1, 2, 3)

Here is the abstract:

Session 911 - Highlighted Original Research: Prevention and the Year in Review

911-12 - Impact on Cardiovascular Outcomes Among E-Cigarette Users: A Review From National Health Interview Surveys

Mohinder R. Vindhyal, Paul Ndunda, Cyrus Munguti, Shravani Vindhyal, Hayrettin Okut, University of Kansas School of Medicine - Wichita, Wichita, KS, USA

Background: Since the introduction of E-Cigarettes(E-cigs) in 2007, their sales have almost increased by 14 - fold in the last decade. In the US, the E-Cig users increased to 3.8% of the adult population of which 16% are current smokers and 22% are former smokers. E-cigs have been advertised as a safer alternative to smoking. However, E-cig use, like smoking, delivers ultra-small aerosol particles which may be associated with cardiovascular disease.

Methods: This study is a cross-sectional analysis of the National Health Interview Survey (NHIS) data of 2014 (n= 36,697), 2016 (n=33,028) and 2017(n= 26,742). The following outcomes were analyzed for e-cig users vs. non-users and smoker’s vs. non-smokers: myocardial infarction, hypertension, diabetes, depression/anxiety/emotional problems, circulatory problems, and stroke. For the outcomes, multiple logistic regression model was conducted to determine the covariate-adjusted odds ratio as well as to achieve the most appropriate p-value for the effects in the model. Variables such as age, BMI and sex were considered as covariates in multiple logistic regression models using SAS 9.4 software.

Results: Compared with non-E-Cig-users, E-cigarette users had a lower mean age (32.9 vs 40.4 years) and similar BMI (28.1 vs 28.07). In multiple logistic regression analysis, E-Cig users had higher odds of having myocardial infarction [OR - 1.558, 95% CI (1.447, 1.678), P,0.0001], stroke [OR - 1.297, 95% CI (1.201, 1.400), P<0.0001], depression/anxiety/emotional problems [OR- 2.200, 95% CI (2.063, 2.347), P<0.0001] and circulatory problems [ OR - 1.436, 95% CI (1.251, 1.648), P <0.0001]. E-cig users had lower odds of having diabetes. There was no significant difference between the two groups on the odds of hypertension [OR - 0.971, 95% CI (0.942, 1.001), P = 0.059].

Conclusion: E-cig users have higher odds of myocardial infarction, stroke, depression/anxiety/emotional problems, circulatory problems and lower risk of hypertension and diabetes compared to non-E-cigarette users. However, there is a need for cohort studies to establish the causation linkage for the cardiovascular outcomes described above.

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