An analysis of data from more than 24,000 American adults revealed that dual users did not differ from exclusive smokers of traditional cigarettes for any cardiovascular outcomes. However, the risk of cardiovascular events in people who only vaped was not significantly different from the risk in those who neither vaped nor smoked traditional cigarettes, researchers report in Circulation.
"The fact that dual use - using both traditional, combustible cigarettes and e-cigarettes - had similar cardiovascular disease risk to smoking cigarettes only is an important finding as many Americans are taking up e-cigarettes in an attempt to reduce smoking for what they perceive is a lower risk," senior author Dr. Andrew C. Stokes of the Boston University School of Public Health said in a press release. "It is common for people to try to switch from traditional cigarettes to e-cigarettes and get caught in limbo using both products."
To take a closer look at the impact of e-cigarette use, especially in conjunction with traditional cigarettes, Dr. Stokes and his colleagues turned to data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study with five annual waves of self-reported information on health and nicotine product use from 2013 to 2019.
The researchers focused their analysis on 24,027 PATH Study participants, 50% of whom were younger than 35. There were 1,487 incident cases of heart attack, heart failure, stroke or other cardiovascular events.
The participants were grouped into categories: no current e-cigarette or traditional cigarette use (14,832); exclusive e-cigarette use (822); traditional cigarette use only (6,515); and dual use of traditional cigarettes and e-cigarettes (1,858).
In their analysis, Dr. Stokes and his colleagues defined a cardiovascular event as any self-reported diagnosis of heart attack or bypass surgery, heart failure, other heart conditions or stroke. The researchers also assessed risk separately for heart attacks, heart failure and stroke.
Compared with nonusers, people who smoked only traditional cigarettes had a 53% increased risk of any cardiovascular disease (adjusted hazard ratio, 1.53; 95% CI, 1.30 to 1.79) and dual users had a 54% risk increase (aHR, 1.54; 95% CI, 1.21 to 1.96).
The adjusted hazard ratio with exclusive e-cigarette use was 1.00 (95% CI, 0.69 to 1.45), but they cautioned that this part of the analysis was limited by the small number of cardiovascular events in people who only vaped.
The new findings did not surprise Dr. Panagis Galiatsatos, an assistant professor in the department of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine and director of the Tobacco Treatment Clinic at Johns Hopkins Medicine, in Baltimore, Maryland.
"E-cigarettes contain chemical toxins, known noxious stimuli to the lungs," said Dr. Galiatsatos, who was not involved in the study. "Damage to the lungs can set off systemic inflammation. That is why patients with COPD have a higher risk of cardiovascular events, such as heart attack and stroke. What's bad for the lungs is bad for the body."
Dr. Galiatsatos suspects that future research, with bigger numbers of participants, will find that vaping also harms the heart.
Dr. Stokes did not respond to requests for comment.
SOURCE: https://bit.ly/3kUubZm Circulation, online May 6, 2022.
By Linda Carroll
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