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Paper on e-cigarette use and MI risk retracted
A study published in the Journal of the American Heart Association in June 2019 concluding that patients who smoked electronic cigarettes every day or some days had an increased risk for MI was retracted on Feb. 18, 2020.
The journal attributed its decision to learning that the study did not account for certain information in the Population Assessment of Tobacco and Health wave 1 survey.
“During the peer review, the reviewers identified the important question of whether the myocardial infarctions occurred before or after the respondents initiated e-cigarette use and requested that the authors use additional data in the PATH codebook (age of first MI and age of first e-cigarettes use) to address the concern,” according to the retraction letter. “While the authors did provide some additional analysis, the reviewers and editors did not confirm that the authors had both understood and complied with the request prior to acceptance of the article for publication.”
After publication, the authors were asked by editors of the journal to conduct the analysis on time of e-cigarette use initiation, but the analysis could not be performed by the time of the given deadline because the authors could not access the database. Based on this, the editors have concerns that the conclusion may be unreliable, according to the letter.
Dharma N. Bhatta, PhD, MPH, postdoctoral scholar at the Cardiovascular Research Institute, School of Medicine at University of California, San Francisco, and Stanton A. Glantz, PhD, professor of medicine School of Medicine at University of California, San Francisco, analyzed data from the Population Assessment of Tobacco and Health (PATH) wave 1 (n = 32,320) and wave 2 (n = 28,362). Participants were asked whether a health professional has every told them that they had an MI, in addition to other questions focused on high BP, high cholesterol and diabetes.
Participants were also categorized based on their response to questions regarding e-cigarette and combustible cigarette use: every-day smokers, some-day smokers, former smokers and never smokers.
Increased odds for MI were seen in participants who were every-day (adjusted OR = 2.25; 95% CI, 1.23-4.11) and some-day e-cigarette users (aOR = 1.99; 95% CI, 1.11-3.58), both of which had a significant dose response (P < .0005).
Compared with participants who never smoked cigarettes or used e-cigarettes, those who used both types of cigarettes had an OR of 6.64 for having an MI.
MIs that occurred during wave 1 of the study were not predictors of e-cigarette use in wave 2 (P > .62), which suggested that reverse causality did not explain the cross-sectional link between e-cigarette use and MI during wave 1, according to the study.
“E-cigarettes should not be promoted or prescribed as a less risky alternative to combustible cigarettes and should not be recommended for smoking cessation among people with or at risk of myocardial infarction,” Bhatta and Glantz wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
Editor's Note: This article was updated on Feb. 19, 2020, to add information on the retraction of the published study.
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Bhatta DN, et al. J Am Heart Assoc. 2019;doi:10.1161/JAHA.119.012317.
The Editors of the Journal of the American Heart Association. J Am Heart Assoc. 2020;doi: 10.1161/JAHA.119.014519.