E-cigarette use rose among ex-smokers with CVD in 2020

Key takeaways:

• E-cigarette use among former cigarette smokers with CVD rose from 3.2% in 2014 to 10.1% in 2020.
• It is uncertain whether replacing traditional cigarettes with e-cigarettes improves cardiovascular health.

E-cigarette use increased overall and in those with a history of CVD who quit cigarette smoking from 2019 to 2020, according to a study published in JAMA Network Open.

Previous research has shown an association between e-cigarette use and adverse cardiovascular events, Xin Wen, MD, from the Second Affiliated Hospital of Harbin Medical University in China, and colleagues wrote.

“Thus, our cross-sectional study aimed to assess trends of e-cigarette use among adults with CVD to provide insight into the direction for future management of e-cigarette use,” they added.

The researchers evaluated 2014 to 2020 National Health Interview Survey data on 30,465 participants with a mean age of 65 years, 47.8% of whom were women.

Wen and colleagues found that the weighted prevalence of e-cigarette use declined from 5.2% from 2014 to 3.1% in 2019. However, the prevalence rebounded to 5.2% in 2020. E-cigarette use among patients with CVD who quit smoking also jumped from 3.2% in 2015 to 10.1% in 2020.

Additionally, those who quit combustible tobacco (OR = 1.8; 95% CI, 1.2-2.7) and those who tried but failed to quit tobacco in the last year (OR = 2; 95% CI, 1.5-2.6) were more likely to use e-cigarettes compared with current combustible smokers.

Among participants aged 60 years and older, e-cigarette use decreased from 2.9% in 2014 to 0.9% in 2020. In contrast, e-cigarette use among those aged younger than 60 years rose from 6.2% in 2014 to 7.2% in 2020.

Although men were more likely to use e-cigarettes than women before 2018, “the trend was reversed in 2019 and 2020,” the researchers wrote.

Wen and colleagues noted that the sudden increase in e-cigarette prevalence after a period of decline “may be explained by increased psychological burden during the COVID-19 pandemic.”

As for patients with CVD who quit smoking, “e-cigarettes may help control tobacco consumption, but whether the replacement of traditional cigarettes with e-cigarettes helps smokers improve cardiovascular health needs further verification,” the researchers wrote.

However, they added that given the reported cardiovascular risks from e-cigarette use, smoking cessation “may be more beneficial for cardiovascular secondary prevention.”

Although the study was limited because self-reporting, Wen and colleagues wrote that the findings among those with CVD was noteworthy, “especially among younger individuals and women and ex-smokers.”

“Further studies are needed to understand the cardiovascular effects of e-cigarettes compared with combustible tobacco to inform future legislation for cardiovascular health,” they concluded.