Introduction
Electronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional
cigarettes and have grown in popularity. Experimental and clinical evidence suggests
that they could increase the risk of myocardial infarction.
Methods
The National Health Interview Surveys of 2014 (n=36,697) and 2016 (n=33,028) were used to examine the cross-sectional association between e-cigarette
use (never, former, some days, daily) and cigarette smoking (same categories) and
myocardial infarction in a single logistic regression model that also included demographics
(age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia)
using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017
and 2018.
Results
Daily e-cigarette use was independently associated with increased odds of having had
a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p<0.001). Former and some day e-cigarette use were not significantly associated with
having had a myocardial infarction (p=0.608 and p=0.392) whereas former (OR=1.70, p<0.001) and some day cigarette smoking (OR=2.36, p<0.001) were. Odds of a myocardial infarction were also increased with history of
hypertension (OR=2.32, p<0.001); high cholesterol (OR=2.36, p<0.001); and diabetes (OR=1.77, p<0.001); and age (OR=1.65 per 10 years, p<0.001). Women (OR=0.47, p<0.001) had lower odds of myocardial infarction.
Conclusions
Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other
risk factors, is associated with increased risk of myocardial infarction.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- E-cigarettes: a scientific review.Circulation. 2014; 129: 1972-1986
- Cardiovascular perspective of the promises and perils of e-cigarettes.Circ Res. 2016; 118: 1872-1875
- Levels of selected carcinogens and toxicants in vapour from electronic cigarettes.Tob Control. 2014; 23: 133-139
- Chemical hazards present in liquids and vapors of electronic cigarettes.Arch Toxicol. 2014; 88: 1295-1308
- Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage.Nicotine Tob Res. 2014; 16: 1319-1326
- Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship.Circulation. 2009; 120: 941-948
- Differences in blood pressure and vascular responses associated with ambient fine particulate matter exposures measured at the personal versus community level.Occup Environ Med. 2011; 68: 224-230
- Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke.Circulation. 1997; 96: 1089-1096
- Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis.Circulation. 2012; 126: 2177-2183
- Acute impact of tobacco vs electronic cigarette smoking on oxidative stress and vascular function.Chest. 2016; 150: 606-612
- Increased cardiac sympathetic activity and oxidative stress in habitual electronic cigarette users: implications for cardiovascular risk.JAMA Cardiol. 2017; 2: 278-284
- Prognostic value of coronary vascular endothelial dysfunction.Circulation. 2002; 106: 653-658
- Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events.Circulation. 2003; 107: 2805-2809
- Electronic cigarette exposure triggers neutrophil inflammatory responses.Respir Res. 2016; 17: 56
- Platelet activation, adhesion, inflammation, and aggregation potential are altered in the presence of electronic cigarette extracts of variable nicotine concentrations.Platelets. 2016; 27: 694-702
- Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice.J Appl Physiol (1985). 2018; 124: 573-582
Centers for Disease Control and Prevention (CDC). NHIS—National Health Interview Survey Homepage. www.cdc.gov/nchs/nhis/index.htm. Accessed September 20, 2017.
Centers for Disease Control and Prevention (CDC). 2016 National Health Interview Survey (NHIS) Public Use Data Release: Survey Description (page 99). ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2016/srvydesc.pdf. Published 2017. Accessed September 20, 2017.
- Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports.BMJ. 2018; 360: j5855
- Encyclopedia of Biostatistics: Bias Toward the Null .John Wiley & Sons, New York, NY2005.
- The risk of myocardial infarction after quitting smoking in men under 55 years of age.N Engl J Med. 1985; 313: 1511-1514
- Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case- control study.Lancet. 2006; 368: 647-658
- Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23).BMJ. 1998; 316: 823-828
- The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up.Arch Intern Med. 2004; 164: 1422-1426
- Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC-Potsdam study.Eur J Cardiovasc Prev Rehabil. 2007; 14: 65-71
- Risk of myocardial infarction attributable to elevated levels of total cholesterol among hypertensives.Am J Hypertens. 2005; 18: 759-766
- Reliability of questionnaire information on cardiovascular disease and diabetes: cardiovascular disease study in Finnmark county.J Epidemiol Community Health. 1982; 36: 269-273
- Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.J Clin Epidemiol. 2004; 57: 1096-1103
Article Info
Publication History
Published online: August 22, 2018
Identification
Copyright
© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Alzahrani T, Pena I, Temesgen N, Glantz SA. Association between electronic cigarette use and myocardial infarction. Am J Prev Med. 2018;55(4):455–461.American Journal of Preventive MedicineVol. 57Issue 4
- E-cigarette Use and Myocardial Infarction: Association Versus Causal InferenceAmerican Journal of Preventive MedicineVol. 56Issue 4
- Association of Electronic Cigarette Use With Myocardial Infarction: Persistent UncertaintyAmerican Journal of Preventive MedicineVol. 56Issue 1
- PreviewWe read with interest the cross-sectional analysis of the National Health Interview Surveys by Alzahrani et al.,1 specifically the finding of the association of electronic cigarette (EC) use with prior myocardial infarction (MI). Of concern, however, is the fact that 95% of EC users were also former or current tobacco cigarette (TC) smokers, and the timing of the MI relative to onset of EC use is unknown. For example, did the MI occur while the participant was a TC smoker, and EC use initiated later as a smoking-cessation strategy?2 The authors considered this possibility and did attempt to control for TC smoking as a confounding factor in their regression model.
- Full-Text
- Preview
