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
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.