Research Brief
Risk of Stroke With E-Cigarette and Combustible Cigarette Use in Young Adults

https://doi.org/10.1016/j.amepre.2019.10.008Get rights and content

Introduction

Rising trends in stroke incidence and hospitalizations because of combustible cigarette smoking have been noted among younger adults. However, the association between e-cigarette use and stroke in this population remains largely unknown. This study examines the association between e-cigarette use with or without a history of previous or concurrent combustible cigarette use and stroke among young adults.

Methods

Pooled data (2016–2017) were analyzed from the Behavior Risk Factor Surveillance System, a nationally representative, cross-sectional telephone survey, in 2019. The sample size was 161,529 participants aged 18–44 years. The association between e-cigarette use and stroke was examined using logistic regression adjusting for patient demographics, relevant comorbidities without or with history, and concurrent use of combustible cigarette use.

Results

Current dual use of e-cigarettes and combustible cigarettes was associated with 2.91 times higher odds of stroke versus nonsmokers (AOR=2.91, 95% CI=1.62, 5.25) and 1.83 times higher odds versus current sole combustible cigarette users (AOR=1.83, 95% CI=1.06, 3.17). Compared with nonsmokers, current sole e-cigarette users did not show significantly different odds of stroke (AOR=0.69, 95% CI=0.34, 1.42). However, odds of stroke were lower for sole e-cigarette users versus current sole combustible cigarette users (AOR=0.43, 95% CI=0.20, 0.93).

Conclusions

Sole e-cigarette use is not associated with greater odds of stroke in young adults. However, if young adults have former or current combustible cigarette use, odds of stroke are significantly increased even compared with current sole combustible cigarette use. Switching from combustible cigarettes to e-cigarettes does not confer stroke benefits.

Section snippets

INTRODUCTION

The use of e-cigarettes has increased considerably among smokers and nonsmokers in the U.S. since 2010.1, 2, 3 The potential ingredients that contribute to an adverse cardiovascular state with e-cigarette smoking include nicotine, oxidants, aldehydes, particulates, and flavorants, as well as lead in certain disposable devices.4,5 A meta-analysis of 14 studies including 441 participants corroborates the acute adverse effects of e-cigarette use on heart rate and blood pressure.6 However, the

METHODS

This study analyzed data from the 2016–2017 Behavior Risk Factor Surveillance System (BRFSS) in 2019 to investigate the prevalence of e-cigarette and combustible cigarette-use among young adults aged 18–44 years. BRFSS is a national annual, cross-sectional health survey conducted jointly by the Centers for Disease Control and Prevention, all U.S. states, and participating territories.11 The authors assessed e-cigarette and combustible cigarette use and stroke using standard questions from the

RESULTS

This analysis included 161,529 participants aged 18–44 years (women, 53.1%; white, 50.6%; Hispanic, 23.9%; income ≥$50,000, 47.9%; unmarried, 50.3%). Of current sole e-cigarette users, most were aged 18–24 years (68.9%), and most current sole combustible cigarette users were aged 35–44 years (47.2%). Compared with nonsmoking, current sole e-cigarette-use and current dual use were associated with higher rates of college dropout or high school graduation, unmarried status, obesity, and binge

DISCUSSION

This cross-sectional study found significantly higher odds of stroke among current dual users compared with nonsmokers and current sole combustible cigarette users, respectively. Furthermore, current sole e-cigarette use was not associated with higher odds of stroke as compared with nonsmokers, although odds were lower compared with current sole combustible cigarette use. These findings have clear implications for physicians, public health agencies, and tobacco product regulation authorities.

CONCLUSIONS

These findings suggest higher odds of stroke in current sole combustible cigarette smokers or current dual users compared with nonsmokers aged 18–44 years. Sole e-cigarette use was not independently associated with stroke events in young adults. Switching from combustible cigarette smoking to e-cigarette use did not curtail risk of stroke in young adults. These findings emphasize the critical need to conduct longitudinal studies exploring the clear benefit and risks of current smoking-cessation

ACKNOWLEDGMENTS

The authors thank Alison Cuellar (George Mason University, Fairfax) for her comments on an earlier version of the manuscript.

All authors contributed equally and have reviewed and approved the final manuscript as submitted.

No financial disclosures were reported by the authors of this paper.

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