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.
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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
- In BriefWe 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.
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- In Brief
