American Heart Association publishes study: Mixing e-cigarettes and cigarettes does not reduce heart disease risk

DALLAS, May 6, 2022 — People who use both traditional (combustible) cigarettes and e-cigarettes compared to those who only use traditional cigarettes, according to new research published today in the American Heart Association’s flagship peer-reviewed journal Circulation. People do not reduce the risk of cardiovascular disease.

Conventional cigarettes are a recognized cause of a variety of serious health conditions. According to the American Heart Association’s Heart Disease and Stroke Statistics – 2022 Update, nearly one in five deaths in the U.S. each year is attributable to smoking and secondhand smoke. E-cigarettes, which contain many chemicals, are gaining popularity as another way for people to ingest nicotine.

Andrew C said: “The fact that the cardiovascular risk of mixing conventional combustible cigarettes and e-cigarettes is similar to smoking is an important finding because many Americans are using e-cigarettes in an attempt to reduce smoking because of what they perceive as the risks of e-cigarettes. lower.” Dr. Stokes, the study’s corresponding and senior author, is an assistant professor in the Department of Global Health at the Boston University School of Public Health. “It’s common for people to try to switch from traditional cigarettes to e-cigarettes, and mixing the two products is common.”

To examine the relationship between cardiovascular disease, e-cigarette use, and the dual use of traditional cigarettes and e-cigarettes, researchers reviewed data from the Population Assessment of Tobacco and Health (PATH) study, a nationally representative study, Five waves of annual self-reported information on health and nicotine product use were collected from 2013 to 2019. After adjusting for age, gender and race/ethnicity, the study focused on more than 24,000 adults, 50% of whom were 35 or younger and 51% female.

Participants were classified as smokers if they had smoked more than 100 combustible cigarettes in their lifetime and reported current smoking during any round of data collection. E-cigarette users were identified by participants self-reporting any e-cigarette use during any round of data collection. Group classifications were: 1) no current e-cigarette use or traditional smoking (14,832; this group could include ex-smokers or former e-cigarette users); 2) only e-cigarette use (822); 3) only traditional cigarette use (6,515); or 4) a combination of traditional cigarettes and e-cigarettes (1,858).

The analysis defined a cardiovascular disease event as any self-reported diagnosis of a heart attack or bypass surgery, heart failure, other heart disease or stroke within the past 12 months. The researchers also assessed individual outcomes of only self-reported heart attack, heart failure or stroke. The review found more than 1,480 cases of cardiovascular disease and more than 500 cases of heart attack, heart failure or stroke.

The analysis of all study participants found:

Compared with people who smoked traditional cigarettes only, there was no significant difference in the risk of any cardiovascular disease and the risk of heart attack, heart failure or stroke between people who smoked conventional cigarettes and those who used e-cigarettes.

E-cigarette-only users and those who use both traditional cigarettes and e-cigarettes are younger than those who use both products: 62% of e-cigarette-only users and 54% of dual users are under the age of 35 and are classified as Among participants who were classified as non-users who did not smoke traditional cigarettes or use e-cigarettes, it was 51 percent.

The researchers noted that e-cigarette use alone had 30%-40% lower self-reported cardiovascular disease events compared to traditional smoking, although this association is important for any cardiovascular outcome, including congenital heart disease or myocarditis, among others. Disease (41 events reported by e-cigarette users, 569 reported by smokers), rather than specifically for heart attack, heart failure or stroke (15 events reported by e-cigarette users, 242 reported by smokers). Given the low number of self-reported outcomes reported by e-cigarette users, the researchers concluded that more data is needed in this field.

“While the PATH study is providing basic longitudinal data on outcomes such as traditional cigarette and e-cigarette use and cardiovascular events, the data are self-reported, the study duration is short, and event rates remain low – especially in young adults Medium. As e-cigarette use is still relatively new, there is not yet substantial long-term evidence to determine the ultimate risks of using these products over time, so we look forward to more data from this and other ongoing studies .

It is important to remember that even with conventional cigarettes, decades of use and monitoring are required to provide the evidence we have now of the significant harms of combustible cigarettes,” said American Heart Association Deputy Chief Scientific and Medical Officer, American Heart Rose Marie Robertson, co-director of the association’s National Institutes of Health/Food and Drug Administration-funded Center for Tobacco Regulatory Science, said the center supported the study.

“People should be aware that e-cigarettes contain addictive nicotine and toxic chemicals that may adversely affect their cardiovascular system and overall health.”

Among several limitations of the study, an important one the researchers noted was the low number of personal and cardiovascular events in the exclusive e-cigarette use group. While only 15 people who exclusively used e-cigarettes reported a diagnosis of heart attack, heart failure or stroke, the number of individuals and events was too small to draw firm conclusions about the effects of exclusive e-cigarette use in the study sample.

“Many smokers who are trying to use e-cigarettes to stop traditional smoking cessation actually continue to use both products, becoming dual users, and we see no reduction in cardiovascular risk,” Stokes said. Both recommendations may lead to increased dual use among young people and never-smokers, as well as the initiation of e-cigarettes.”

“E-cigarettes are not approved by the U.S. Food and Drug Administration (FDA) for smoking cessation. We urge anyone who smokes and is interested in quitting to speak with their doctor and healthcare team about other FDA-approved effective smoking cessation options,” Robertson said .

The American Heart Association’s Center for Tobacco Regulatory Science received funding for the study through a grant from the United States. FDA Center for Tobacco Products through the National Heart, Lung, and Blood Institute of the National Institutes of Health. Through the center, the American Heart Association works closely with investigators at institutions across the country to conduct research to increase existing knowledge about the health effects of smoking and nicotine-related products, including e-cigarettes, findings that can help inform public health and tobacco Product Stewardship provides information.

Co-author is Jonathan B. Berowitz, B.A.; Wubin Xie, Dr.P.H., M.P.H.; Alyssa F. Harlow, M.D., M.P.H.; Naomi M. Hamburg, M.D.; Michael J. Blaha, M.D., M.P.H.; Aruni Bhatnagar, Ph.D., FAHA; and Emelia J. Benjamin, MD, Sc.M., FAHA.