Abstract 9: Electronic Cigarette Use is Associated With a Higher Risk of Stroke

Abstract

Introduction: In 2016, 3.2% of US adults and 11.3% of high school students reported using electronic cigarettes (e-cigarettes) in the preceding 30 days. Its use among young people increased by 900% between 2011 and 2015. Stroke occurs in 795,000 people and causes 133,000 deaths annually in the US. The association between e-cigarette use and stroke is unknown. The purpose of this study was to determine the association between e-cigarette use and stroke. Methods: The study is an analysis of the 2016 Behavioral Risk Factor Surveillance System (BRFSS) an annual chronic disease and behavioral risk factor survey conducted by the CDC. The sample included 66,795 respondents that reported ever regularly using e-cigarettes. The control group was the 343,856 respondents that reported never using e-cigarettes. Odds ratios were calculated using logistic regression analysis. Among the covariates tested, age, sex, smoking status, diabetes, exercise and Body Mass Index (BMI) categories showed significant effects on the model and were adjusted for in the outcomes. Results: Overall 21% of BRFSS respondents reported ever using e-cigarettes, with 48.5% of them being female (P <0.0001). Compared with non-users, e-cigarette users had a lower mean age (44 vs 57 years [P <0.0001]), lower mean BMI (27.7 vs 28.1 [P <0.0001]) and a lower rate of diabetes (9.8% vs 12.1% [P <0.0001]). They however had higher rates of cigarette smoking (78.7% vs 37.4% [P <0.0001]). Compared with non-users, e-cigarette users had higher adjusted odds of stroke (OR 1.71 [1.64 - 1.8]), myocardial infarction (OR 1.59 [1.53 - 1.66]), angina or coronary heart disease (OR 1.4 [1.35 - 1.46]). Conclusion: E-cigarette use is associated with higher odds of stroke, myocardial infarction and angina/coronary heart disease.

E-Cigarette-Only and Dual Use among Adolescents in Ireland: Emerging Behaviours with Different Risk Profiles

“…Evidence that e-cigarettes lead to later tobacco use, a process known as the “gateway” effect, continues to mount [ 11 ]. Emerging literature suggests that the long term adverse effects include myocardial infarction [ 12 ], stroke [ 13 ], respiratory disease [ 14 ], and potential carcinogenic effects [ 15 ].…”

Vaping Induced Cardiac Complications - A Smokescreen Coming to Engulf the Heart?

“…Although two retrospective studies showed an increased risk of stroke [4] and myocardial infarctions [5], there has generally been a lack of evidence from clinical trials or long-term cohort studies regarding the cardiovascular effects and complications of e-cigarettes. Two knowledge gaps have been identified -prospective studies assessing the effects of e-cigarettes on clinical cardiovascular outcomes are lacking, and it is unknown whether different patterns of e-cigarette smoking (with respect to age of onset, frequency and cumulative duration of use) exert differential cardiovascular effects [6].…”

Electronic Cigarettes and Cardiovascular Risk: Caution Waiting for Evidence

“…71 Very recently, in a cross-sectional analysis of 400,000 adult respondents from the 2016 BRFSS survey, almost 70,000 people reported electronic cigarette use, and this was associated with a 71% increased risk of stroke, 59% higher risk of acute MI and a 40% higher risk of angina and coronary artery disease; moreover, they had twice the risk of switching to regular cigarettes. 72 Similarly, in a recent logistic regression analysis performed among the National Health Interview Surveys 2014-2016 population, daily electronic cigarette use, after adjusting for conventional tobacco exposure and other risk factors, was significantly associated with a 79% increase in the odds of suffering an acute MI. 73 In contrast, pooled data from the BRFSS 2016-2017 sample that included almost 450,000 participants failed to find a significant association between sole electronic cigarette use in never-smokers and cardiovascular disease, whereas dual use of electronic cigarettes and combustible cigarettes was associated with a 36% higher odds of cardiovascular disease compared with tobacco smoking alone.…”

“…72 Similarly, in a recent logistic regression analysis performed among the National Health Interview Surveys 2014-2016 population, daily electronic cigarette use, after adjusting for conventional tobacco exposure and other risk factors, was significantly associated with a 79% increase in the odds of suffering an acute MI. 73 In contrast, pooled data from the BRFSS 2016-2017 sample that included almost 450,000 participants failed to find a significant association between sole electronic cigarette use in never-smokers and cardiovascular disease, whereas dual use of electronic cigarettes and combustible cigarettes was associated with a 36% higher odds of cardiovascular disease compared with tobacco smoking alone. 74 Limited data currently exist regarding the general cardiac effects of electronic cigarette smoking.…”