Association Between E-Cigarette Use and Cardiovascular Disease Among Never and Current Combustible-Cigarette Smokers

Albert D. Osei, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Omar Dzaye, S. M.Iftekhar Uddin, Emelia J. Benjamin, Michael E. Hall, Andrew P. DeFilippis, Andrew Stokes, Aruni Bhatnagar, Khurram Nasir, Michael J. Blaha

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background: The prevalence of e-cigarette use in the United States has increased rapidly. However, the association between e-cigarette use and cardiovascular disease remains virtually unknown. Therefore, we aimed to examine the association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers. Methods: We pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. We included 449,092 participants with complete self-reported information on all key variables. The main exposure, e-cigarette use, was further divided into daily or occasional use, and stratified by combustible-cigarette use (never and current). Cardiovascular disease, the main outcome, was defined as a composite of self-reported coronary heart disease, myocardial infarction, or stroke. Results: Of 449,092 participants, there were 15,863 (3.5%) current e-cigarette users, 12,908 (2.9%) dual users of e-cigarettes + combustible cigarettes, and 44,852 (10.0%) with cardiovascular disease. We found no significant association between e-cigarette use and cardiovascular disease among never combustible-cigarette smokers. Compared with current combustible-cigarette smokers who never used e-cigarettes, dual use of e-cigarettes + combustible cigarettes was associated with 36% higher odds of cardiovascular disease (odds ratio 1.36; 95% confidence interval, 1.18-1.56); with consistent results in subgroup analyses of premature cardiovascular disease in women < 65 years and men < 55 years old. Conclusion: Our results suggest significantly higher odds of cardiovascular disease among dual users of e-cigarettes + combustible cigarettes compared with smoking alone. These data, although preliminary, support the critical need to conduct longitudinal studies exploring cardiovascular disease risk associated with e-cigarette use, particularly among dual users.

Original languageEnglish (US)
Pages (from-to)949-954.e2
JournalAmerican Journal of Medicine
Volume132
Issue number8
DOIs
StatePublished - Aug 2019

Keywords

  • Cardiovascular disease
  • Combustible cigarettes
  • Dual use
  • E-cigarettes

ASJC Scopus subject areas

  • Medicine(all)

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