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Chen C, Huo C, Mattey-Mora PP, Bidulescu A, Parker MA. Assessing the association between e-cigarette use and cardiovascular disease: A meta-analysis of exclusive and dual use with combustible cigarettes. Addict Behav 2024; 157:108086. [PMID: 38917766 DOI: 10.1016/j.addbeh.2024.108086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Growing evidence highlights the impact of e-cigarette use on cardiovascular health, prompting a crucial examination of its association with cardiovascular disease (CVD) in both exclusive e-cigarette and dual use scenarios with combustible cigarettes. This meta-analysis assessed the association between e-cigarette use and CVD by synthesizing the existing literature. METHODS Pertinent observational studies were identified using multiple electronic databases, from August 22nd, 2006, to April 10th, 2024. A meta-analysis was conducted using random-effect models. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. FINDINGS A total of 20 observational studies involving 8,499,444 participants were included in the meta-analysis. Dual use (e-cigarettes and combustible cigarette) increased the odds of CVD by 2.56 times (95 % CI: 2.11, 3.11) compared to never use of both. Current e-cigarette use combined with former combustible cigarette increased the odds of CVD by 2.02 times (95 % CI: 1.58, 2.58) compared to never use of either. Exclusive current e-cigarette use did not show a statistically significant association with CVD odds compared to never use of either (OR = 1.24, 95 % CI: 0.93, 1.67). CONCLUSIONS Dual use of e-cigarettes and combustible cigarettes was significantly associated with CVD, but results failed to show a significant association between exclusive e-cigarette use and CVD. Robust and longitudinal studies are needed to understand the long-term implications of e-cigarette use and CVD. Public health efforts should focus on awareness, smoking cessation, and regulating both e-cigarettes and combustible cigarettes.
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Affiliation(s)
- Chen Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Cuiqiong Huo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Paola P Mattey-Mora
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Maria A Parker
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
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Kale D, Brown J, Dawkins L, Goniewicz ML, Leppin C, Tattan-Birch H, Shahab L. Comparing identity, attitudes, and indicators of effectiveness in people who smoke, vape or use heated tobacco products: A cross-sectional study. Addict Behav 2024; 151:107933. [PMID: 38142579 DOI: 10.1016/j.addbeh.2023.107933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. METHODS Adults exclusive cigarette smokers (N = 45) and ex-smokers with medium/long-term (>3months) NVP (N = 46) or HTP use (N = 45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. RESULTS In adjusted analysis, people who used cigarettes (Mean Difference (MD) = 1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD = 0.8, 95%CI 0.1, 1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD = 3.0, 95%CI 1.6, 4.3; MD = 3.1, 95%CI 1.9, 4.3, respectively), and higher intention to stop product use (MD = -0.8, 95%CI -1.7,-0.01; MD = -1.2, 95%CI -2.0, -0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M = 3.4, 95%CI 2.8, 3.9; NVP:M = 3.0, 95%CI 2.5, 3.5), efficacy for smoking cessation (HTP:M = 4.5, 95%CI 4.2, 4.9; NVP:M = 4.6, 95%CI 4.3, 4.9) and safety (HTP:M = 2.1, 95%CI 2.0, 2.2; NVP:M = 2.0, 95%CI 1.8, 2.1). HTP users reported greater perceived addictiveness than NVPs (MD = 0.3, 95%CI 0.2, 0.6). CONCLUSIONS HTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK.
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Corinna Leppin
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
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Glantz SA, Nguyen N, Oliveira da Silva AL. Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes. NEJM EVIDENCE 2024; 3:EVIDoa2300229. [PMID: 38411454 DOI: 10.1056/evidoa2300229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND: E-cigarettes are promoted as less harmful than cigarettes. There has not been a direct comparison of health effects of e-cigarettes or dual use (concurrently using e-cigarettes and cigarettes) with those of cigarettes in the general population. METHODS: Studies in PubMed, EMBASE, Web of Science, and PsychINFO published through October 1, 2023, were pooled in a random-effects meta-analysis if five or more studies were identified with a disease outcome. We assessed risk of bias with Risk Of Bias In Non-randomized Studies of Exposure and certainty with Grading of Recommendations, Assessment, Development, and Evaluations. Outcomes with fewer studies were summarized but not pooled. RESULTS: We identified 124 odds ratios (94 cross-sectional and 30 longitudinal) from 107 studies. Pooled odds ratios for current e-cigarette versus cigarette use were not different for cardiovascular disease (odds ratio, 0.81; 95% confidence interval, 0.58 to 1.14), stroke (0.73; 0.47 to 1.13), or metabolic dysfunction (0.99; 0.91 to 1.09) but were lower for asthma (0.84; 0.74 to 0.95), chronic obstructive pulmonary disease (0.53; 0.38 to 0.74), and oral disease (0.87; 0.76 to 1.00). Pooled odds ratios for dual use versus cigarettes were increased for all outcomes (range, 1.20 to 1.41). Pooled odds ratios for e-cigarettes and dual use compared with nonuse of either product were increased (e-cigarette range, 1.24 to 1.47; dual use, 1.49 to 3.29). All included studies were assessed as having a low risk of bias. Results were generally not sensitive to study characteristics. Limited studies of other outcomes suggest that e-cigarette use is associated with additional diseases. CONCLUSIONS: There is a need to reassess the assumption that e-cigarette use provides substantial harm reduction across all cigarette-caused diseases, particularly accounting for dual use.
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Affiliation(s)
| | - Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco
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Cook S, Buszkiewicz JH, Levy DT, Meza R, Fleischer NL. Association between cigar use, with and without cigarettes, and incident diagnosed COPD: a longitudinal cohort study. Respir Res 2024; 25:13. [PMID: 38178199 PMCID: PMC10765880 DOI: 10.1186/s12931-023-02649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND While regular cigar smoking is believed to carry similar health risks as regular cigarette smoking, the impact of cigar use, alone or in combination with cigarettes, on obstructive pulmonary disease (COPD) has not been well characterized. The purpose of this study was to examine the prospective association between exclusive and dual cigar and cigarette use and incident self-reported diagnosed COPD. METHODS This study used data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey of U.S. adults. Longitudinal data from adults aged 40 to 79 at Wave 1, without a pre-existing COPD diagnosis who participated at follow-up interview were analyzed. A time-varying current tobacco exposure, lagged by one wave and categorized as: (a) never/non-current use; (b) exclusive cigar use; (c) exclusive cigarette use; and (d) dual cigar/cigarette use. Multivariable models adjusted for demographics (age, sex, race or ethnicity, education), clinical risk factors (asthma, obesity), and smoking-related confounders (second-hand smoke exposure, other combustible tobacco product use, e-cigarette use, time since quitting, cigarette pack-years). The incidence of self-reported diagnosed COPD was estimated using discrete-time survival models, using a general linear modeling (GLM) approach with a binomial distribution and a complementary log-log link function. RESULTS The analytic sample consisted of 9,556 adults with a mean (SD) age of 56 (10.4), who were predominately female (52.8%) and Non-Hispanic White (70.8%). A total of 906 respondents reported a diagnosis of COPD at follow-up. In the fully adjusted model, exclusive cigar use (adjusted hazard ratio (aHR) = 1.57, 95% CI: 0.77, 3.21) was not associated with increased COPD risk compared to non-use, while exclusive cigarette use (aHR = 1.48, 95% CI: 1.13, 1.93) and dual cigar/cigarette use (aHR = 1.88, 95% CI: 1.24, 2.85) were. CONCLUSIONS Exclusive cigarette use and dual cigar/cigarette use were associated with diagnosed incident COPD. These results suggest that cigars, when used in combination with cigarettes, may be associated with poorer COPD health outcomes. Dual use may promote a higher likelihood of inhaling cigar smoke, and future research would benefit from examining whether inhalation of cigar smoke increases COPD risk.
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Affiliation(s)
- Steven Cook
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - James H Buszkiewicz
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - David T Levy
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, USA
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Awad K, Mohammed M, Martin SS, Banach M. Association between electronic nicotine delivery systems use and risk of stroke: a meta-analysis of 1,024,401 participants. Arch Med Sci 2023; 19:1538-1540. [PMID: 37732043 PMCID: PMC10507757 DOI: 10.5114/aoms/171473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction To evaluate the relationship between electronic nicotine delivery systems (ENDS) use and the risk of stroke when compared to non-smokers. Methods A comprehensive search was conducted until June 15, 2023. We included observational studies that assessed association of current or former usage of ENDS with risk of stroke compared with non-smokers, reported the risk estimate as odds ratio (OR) or hazard ratio (HR) and were adjusted for possible confounders. Results 6 studies with 1,024,401 participants were included in our analysis. ENDS use was associated with a significant increased risk of stroke (OR = 1.52; 95% CI: 1.17-1.97) compared with non-users. A non-significant association was found between former ENDS use and risk of stroke (OR = 1.03; 95% CI: 0.87-1.21). Conclusions The ENDS usage appears to be associated with a higher risk of stroke compared to non-use, whereas there was no association between former ENDS use and the risk of stroke.
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Affiliation(s)
- Kamal Awad
- Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
- Primary Health Care Centers, Health Insurance Organization, El-Sharkia, Egypt
| | - Maged Mohammed
- Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
| | - Seth S. Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
| | - Maciej Banach
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
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Fountoulakis P, Theofilis P, Tsalamandris S, Antonopoulos AS, Tsioufis P, Toutouzas K, Oikonomou E, Tsioufis K, Tousoulis D. The cardiovascular consequences of electronic cigarette smoking: a narrative review. Expert Rev Cardiovasc Ther 2023; 21:651-661. [PMID: 37755116 DOI: 10.1080/14779072.2023.2264179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/25/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION E-cigarettes have emerged as a popular alternative to traditional tobacco smoking in recent years. Despite their growing popularity, concerns have arisen regarding the cardiovascular implications of e-cigarette use. AREAS COVERED This narrative review aims to highlight the latest evidence on the impact of e-cigarettes on cardiovascular health. EXPERT OPINION Numerous studies have demonstrated that e-cigarette use can lead to acute adverse cardiovascular effects. Inhalation of e-cigarette aerosols exposes users to a wide range of potentially harmful substances that have been implicated in critical pathophysiologic pathways of cardiovascular disease, namely endothelial dysfunction, oxidative stress, inflammation, sympathetic overdrive, and arterial stiffness. While long-term epidemiological studies specifically focusing on the cardiovascular effects of e-cigarettes are still relatively scarce, early evidence suggests a potential association between e-cigarette use and an increased risk of adverse cardiovascular events. However, it is essential to recognize that e-cigarettes are relatively new products, and the full extent of their long-term cardiovascular impact has not been fully elucidated. In the meantime, promoting tobacco cessation strategies that are evidence-based and regulated, along with rigorous monitoring of e-cigarette use patterns and associated health outcomes, are essential steps in safeguarding cardiovascular health in the face of this emerging public health challenge.
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Affiliation(s)
- Petros Fountoulakis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Theofilis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Sotiris Tsalamandris
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Tsioufis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Toutouzas
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
- Cardiology Department, Sotiria Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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