e-Cigarettes Boost Heart Attack Risk, Emotional Stress, Findings Show

Users of e-cigarettes face a higher risk of having a heart attack, experiencing emotional distress, and developing coronary artery disease (CAD) compared to non-users, according to findings to be presented next week at the annual meeting of American College of Cardiology in New Orleans, Louisiana. While e-cigarettes were first marketed as a safer alternative to smoking combustible cigarettes, new evidence suggests that there may be nothing safe about them at all.

Traditional combustible cigarette smoking remains one of the most common causes of chronic obstructive pulmonary disease (COPD). Recent studies have also suggested that e-cigarettes may be equally as dangerous for patients with COPD.

e-Cigarettes have dramatically increased in popularity since their introduction in 2007, with as many as 15 million Americans currently using them, potentially setting the stage for a new public health concern more than 50 years after the Surgeon General first sounded the alarm against combustible tobacco. According to the study’s author, there are currently more than 460 brands of e-cigarettes and over 7700 flavors. Over the last decade, sales have increased nearly 1400% and use has become widespread among adolescents.

In 2018, the CDC reported 3.6 million youths were using e-cigarettes in the United States. From 2017 to 2018, the number of high school age users soared by 78%, rising from 11.7% to 20.8%, while the number of middle school age users grew by 48%, from 3.3% to 4.9%. Critics of e-cigarettes have suggested creation of an abundance of enticing flavors proves manufacturers have specifically marketed their product to adolescents. Outgoing FDA Commissioner, Scott Gottlieb, MD, who will step down at the end of this month, has made reining in e-cigarette use among teens one of his top priorities; he said in announcing stricter regulations on sales that "the data shock the conscience."

The study authors, led by Mohinder Vindhyal, MD, assistant professor at the University of Kansas School of Medicine, Wichita, conducted cross-sectional analysis on data from the CDC’s 2014, 2016, and 2017 National Health Interview Survey. A total of 96,467 respondents were asked questions about ever-cigarette or related tobacco product use, ever-use of e-cigarettes, and frequency of use. Multiple logical regression analysis was performed on the outcomes to determine cardiovascular (CV) risk factors associated with combustible cigarette smoking and e-cigarette use.

Like traditional smoking, e-cigarette use delivers small aerosol particles which may be linked to cardiovascular disease. Researchers found that e-cigarette users were at a 56% greater risk for having a heart attack and were 30% more likely to suffer a stroke. e-Cigarette use also attributed to a 10% higher risk for CAD and a 44% higher chance to develop circulatory problems such as blood clots. Users were also found to be twice as likely to suffer from emotional problems like depression and anxiety.

When results were adjusted for other CV risk factors including age, sex, body mass index, high cholesterol, high blood pressure, and traditional smoking, nearly all of these associations remained true. After adjustment, e-cigarette users were 34% more likely to have a heart attack, 25% more likely to have CAD, and 55% more likely to experience emotional distress. However, stroke, high blood pressure, and circulatory problems no longer statistically varied between the 2 groups.

“When the risk of heart attack increases by as much as 55% among e-cigarettes users compared to nonsmokers, I wouldn’t want any of my patients nor my family members to vape. When we dug deeper, we found that regardless of how frequently someone uses e-cigarettes, daily or just on some days, they are still more likely to have a heart attack or coronary artery disease,” Vindhyal said in a statement.

During the study, researchers examined the rates of high blood pressure, heart attack, stroke, CAD, diabetes, depression, and anxiety among those who reported ever e-cigarette use and nonusers. Individuals who reported using e-cigarettes were an average of 7 years younger than nonusers. Researchers also compared data on tobacco smokers and nonsmokers. Combustible cigarette smokers were found to be at substantially greater risk of having a heart attack by 165%, CAD by 94% and having a stroke by 78%. Traditional smokers also had a greater risk of having high blood pressure, diabetes, circulatory problems, depression, or anxiety.

“Until now, little has been known about cardiovascular events relative to e-cigarette use. These data are a real wake-up call and should prompt more action and awareness about the dangers of e-cigarettes,” said Vindhyal.

There were several limitations in the study. Data were self-reported and therefore subject to recall bias. Data for e-cigarette users may not have been accurate as the definition of e-cigarette use and the duration and amount of their usage has not been sufficiently detailed. Logical regression analysis was limited, fitting only 6 main cardiovascular risk factors. Participants may have had pre-existing cardiovascular morbidities before using e-cigarettes. The author also addressed the need to establish causation links for proposed cardiovascular outcomes in e-cigarette users from long-term cohort studies.

The American College of Cardiology's 68th Annual Scientific Session and Exposition takes place March 16-18, 2019.

Reference

Vindhyal MR, Ndunda P, Munguti C, Vindhyal S, Okut H. Impact on Cardiovascular outcomes among e-cigarette users: a review from National Health Interview Surveys. Presented at: 68th American College of Cardiology Scientific Session and Exposition; March 18, 2019; New Orleans; LA. Abstract no. A-19151.