Vaping with e-cigarettes raises odds of CV events, depression
NEW ORLEANS — Adults who reported using electronic cigarettes had increased odds of MI, CAD and depression or emotional problems compared with nonsmokers, according to new data presented at the American College of Cardiology Scientific Session.
Researchers analyzed the relationship between e-cigarette use and CV and other health outcomes in 96,467 respondents from the CDC’s National Health Interview Survey from 2014, 2016 and 2017.
E-cigarette users — classified as some days or daily — were 55% more likely to have an MI (adjusted OR = 1.558; 95% CI, 1.447-1.678), 29% more likely to have a stroke (aOR = 1.297; 95% CI, 1.201-1.4) and 10% more likely to have CAD (aOR = 1.103; 95% CI, 1.025-1.187) compared with adults who do not use e-cigarettes in multiple logistic regression analyses. Additionally, those who reported using e-cigarettes were twice as likely to have depression, anxiety or emotional problems compared with nonusers (aOR = 2.2; 95% CI, 2.063-2.347).
Comparison of outcomes among those who reported tobacco smoking vs. nonsmokers yielded similarly elevated CV risks, although odds of adverse outcomes were much higher than with e-cigarettes, Mohinder R. Vindhyal, MD, MEd, assistant professor of medicine in the department of internal medicine at the University of Kansas School of Medicine in Wichita, said during a discussion of the data.
Smokers were 165% more likely to have an MI (aOR = 2.652; 95% CI, 2.516-2.796), 94% more likely to have CAD (aOR = 1.948; 95% CI, 1.863-2.037), 78% more likely to have a stroke (aOR = 1.781; 95% CI, 1.691-1.875) and 69% more likely to have depression, anxiety or emotional problems (aOR = 1.694; 95% CI, 1.598-1.798) compared with nonsmokers. Tobacco smokers were also more likely to have high BP, diabetes and other circulatory issues.
All analyses were adjusted for age, sex and BMI, Vindhyal said during a press conference.
Frequent use may affect risk
The researchers performed subgroup analyses of adults who reported daily e-cigarette use and those who reported more occasional use. Compared with nonusers, daily e-cigarette users were 54% more likely to have depression, anxiety or emotional problems (aOR = 1.547; 95% CI, 1.304-1.836), 34% more likely to have an MI (aOR = 1.34; 95% CI, 1.07-1.678) and 25% more likely to have CAD (aOR = 1.252; 95% CI, 1.001-1.567).
More occasional e-cigarette use on some days only was associated with a 29% increased likelihood of MI (aOR = 1.297; 95% CI, 1.076-1.564) compared with nonusers.
Vindhyal noted that these subgroup analyses were adjusted for age, sex, BMI, cholesterol, smoking and hypertension.
A focus on emotional issues
Salim Virani, MD, PhD, FACC, associate professor in cardiology and cardiovascular research sections at Baylor College of Medicine in Houston and ACC Prevention Council Chair, who moderated the ACC web briefing, said that given the observational nature of these findings, these results need to be interpreted with caution. In addition, there are two major messages that came out of this study, including the link between e-cigarette use and higher odds of MI and stroke as well as a higher prevalence of depression, anxiety and other emotional problems.
“There are two important messages from a public health standpoint for the consumers. First, e-cigarettes may be associated with a higher risk of having CV disorders,” Virani said. “Second, if there are going to be interventions to reduce e-cigarette use in our population, then we’re going to have to look at those emotional problems that are concurrent with the use of e-cigarettes. So, depression, anxiety and other emotional problems will need to be addressed at the same time if interventions are going to be successful.”
A call for more research
The current study analyzed National Health Interview Survey data from 2014, 2016 and 2017. Data from 2015 were not included because e-cigarette questionnaire data were not available for that time period.
Vindhyal also noted several limitations of the study.
“National Health Interview Survey data are self-reported because they are based on a questionnaire, which is always subjected to recall bias. The definition of e-cigarette use and the amount and duration of its usage has also not been detailed enough, which may indicate that the data may not be sufficiently accurate,” he said. “Additionally, our participants may have already had CV morbidities such as MI, CAD or stroke even before using e-cigarettes. Logistic regression could also only fit six main CV risk factors.”
However, the growing use of e-cigarettes is significant, Vindhyal said.
“According to CDC data in 2018, there are close to 3.6 million middle school and high school students using e-cigarettes, with use having increased by 78% among high school students and 48% among middle school students in just 1 year from 2017 to 2018. And, as of 2016, there are close to 10.8 million adults using e-cigarettes in the United States,” he said, adding that many of the chemicals contained in e-cigarettes such as nicotine and other metals have been shown to be harmful.
“Our study shows that e-cigarette users have higher odds of having an MI, stroke, circulatory problems and depression or emotional problems,” Vindhyal said. “We have established an association, but we cannot truly establish a causation link, which can only be established in the long-term cohort studies from here on. But we have noted here that there definitely is an association with MI, stroke and depression or anxiety.” – by Melissa Foster
Vindhyal M. Abstract 911-12. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosures: Vindhyal and Virani report no relevant financial disclosures.