Association Between Electronic Cigarette Use and Myocardial Infarction


      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.


      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.


      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.


      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 access
      One-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 to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grana R
        • Benowitz N
        • Glantz SA
        E-cigarettes: a scientific review.
        Circulation. 2014; 129: 1972-1986
        • Bhatnagar A
        Cardiovascular perspective of the promises and perils of e-cigarettes.
        Circ Res. 2016; 118: 1872-1875
        • Goniewicz ML
        • Knysak J
        • Gawron M
        • et al.
        Levels of selected carcinogens and toxicants in vapour from electronic cigarettes.
        Tob Control. 2014; 23: 133-139
        • Hutzler C
        • Paschke M
        • Kruschinski S
        • Henkler F
        • Hahn J
        • Luch A
        Chemical hazards present in liquids and vapors of electronic cigarettes.
        Arch Toxicol. 2014; 88: 1295-1308
        • Kosmider L
        • Sobczak A
        • Fik M
        • et al.
        Carbonyl compounds in electronic cigarette vapors: effects of nicotine solvent and battery output voltage.
        Nicotine Tob Res. 2014; 16: 1319-1326
        • Pope 3rd, CA
        • Burnett RT
        • Krewski D
        • et al.
        Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship.
        Circulation. 2009; 120: 941-948
        • Brook RD
        • Bard RL
        • Burnett RT
        • et al.
        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
        • Lightwood JM
        • Glantz SA
        Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke.
        Circulation. 1997; 96: 1089-1096
        • Tan CE
        • Glantz SA
        Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis.
        Circulation. 2012; 126: 2177-2183
        • Carnevale R
        • Sciarretta S
        • Violi F
        • et al.
        Acute impact of tobacco vs electronic cigarette smoking on oxidative stress and vascular function.
        Chest. 2016; 150: 606-612
        • Moheimani RS
        • Bhetraratana M
        • Yin F
        • et al.
        Increased cardiac sympathetic activity and oxidative stress in habitual electronic cigarette users: implications for cardiovascular risk.
        JAMA Cardiol. 2017; 2: 278-284
        • Halcox JP
        • Schenke WH
        • Zalos G
        • et al.
        Prognostic value of coronary vascular endothelial dysfunction.
        Circulation. 2002; 106: 653-658
        • Targonski PV
        • Bonetti PO
        • Pumper GM
        • Higano ST
        • Holmes Jr, DR
        • Lerman A
        Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events.
        Circulation. 2003; 107: 2805-2809
        • Higham A
        • Rattray NJ
        • Dewhurst JA
        • et al.
        Electronic cigarette exposure triggers neutrophil inflammatory responses.
        Respir Res. 2016; 17: 56
        • Hom S
        • Chen L
        • Wang T
        • Ghebrehiwet B
        • Yin W
        • Rubenstein DA
        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
        • Olfert IM
        • DeVallance E
        • Hoskinson H
        • et al.
        Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice.
        J Appl Physiol (1985). 2018; 124: 573-582
      1. Centers for Disease Control and Prevention (CDC). NHIS—National Health Interview Survey Homepage. Accessed September 20, 2017.

      2. Centers for Disease Control and Prevention (CDC). 2016 National Health Interview Survey (NHIS) Public Use Data Release: Survey Description (page 99). Published 2017. Accessed September 20, 2017.

        • Hackshaw A
        • Morris JK
        • Boniface S
        • Tang JL
        • Milenkovic D
        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
        • Gail MH.
        Encyclopedia of Biostatistics: Bias Toward the Null .
        John Wiley & Sons, New York, NY2005.
        • Rosenberg L
        • Kaufman DW
        • Helmrich SP
        • Shapiro S
        The risk of myocardial infarction after quitting smoking in men under 55 years of age.
        N Engl J Med. 1985; 313: 1511-1514
        • Teo KK
        • Ounpuu S
        • Hawken S
        • et al.
        Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case- control study.
        Lancet. 2006; 368: 647-658
        • Turner RC
        • Millns H
        • Neil HA
        • et al.
        Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23).
        BMJ. 1998; 316: 823-828
        • Almdal T
        • Scharling H
        • Jensen JS
        • Vestergaard H
        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
        • Heidemann C
        • Hoffmann K
        • Klipstein-Grobusch K
        • et al.
        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
        • Glazer NL
        • Smith NL
        • Heckbert SR
        • Doggen CJ
        • Lemaitre RN
        • Psaty BM
        Risk of myocardial infarction attributable to elevated levels of total cholesterol among hypertensives.
        Am J Hypertens. 2005; 18: 759-766
        • Tretli S
        • Lund-Larsen PG
        • Foss OP
        Reliability of questionnaire information on cardiovascular disease and diabetes: cardiovascular disease study in Finnmark county.
        J Epidemiol Community Health. 1982; 36: 269-273
        • Okura Y
        • Urban LH
        • Mahoney DW
        • Jacobsen SJ
        • Rodeheffer RJ
        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

      Linked Article