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Am J Med. 2019 Mar 7. pii: S0002-9343(19)30211-6. doi: 10.1016/j.amjmed.2019.02.016. [Epub ahead of print]

The association between e-cigarette use and cardiovascular disease among never and current combustible cigarette smokers: BRFSS 2016 & 2017.

Author information

1
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, MD.
2
Johns Hopkins University, Baltimore, Maryland and Department of Radiology and Neuroradiology, Charité, Berlin, Germany.
3
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University, Boston, MA.
4
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, MS.
5
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, KY.
6
Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine.
7
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, MD. Electronic address: mblaha1@jhmi.edu.

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 to 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 [OR], 1.36; 95% CI, 1.18-1.56); with consistent results in subgroup analyses of premature cardiovascular disease in women less than 65years and men less than 55years old.

CONCLUSION:

Our results suggest significantly higher odds of cardiovascular disease among dual users of e-cigarettes + combustible cigarettes compared to smoking alone. These data, though preliminary, support the critical need to conduct longitudinal studies exploring cardiovascular disease risk associated with e-cigarette use, particularly among dual users.

KEYWORDS:

cardiovascular disease; combustible cigarettes; dual use; e-cigarettes

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