Young smokers who use both combustible and e-cigarettes have higher risk of stroke

People are looking at e-cigarettes as a "healthy" alternative to cigarettes and we currently have an epidemic of e-cigarettes use.

However, according to a new study in the American Journal of Preventive Medicine, published by Elsevier, young adults who smoke cigarettes plus use e-cigarettes are nearly two times more likely to have a stroke compared to current cigarette-only smokers and nearly three times more likely than non-smokers.

It's long been known that smoking cigarettes is among the most significant risk factors for stroke. Our study shows that young smokers who also use e-cigarettes put themselves at an even greater risk,"

This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative. We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and it's not good."

Tarang Parekh, MBBS, MSc, lead investigator, Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA

E-cigarettes may not be a safe way to stop smoking, the claim made by their purveyors.

Researchers are only beginning to understand the health consequences of e-cigarettes, but the case against them is mounting with recent instances of vaping-related lung injury, as well as studies showing their hazards as a gateway (e-cigarettes users are more likely to start smoking within a shorter period of time than non-users), long-term source of high nicotine concentration, and their role in an inflammatory signaling network that underlies cardiovascular disease.

"Our findings demonstrate an additive harmful effect of e-cigarettes on smokers' blood vessels, hearts and brains," explained Mr. Parekh.

This study calculated the adjusted odds ratios (AORs) for cerebrovascular events among current smokers (compared to non-smokers) at 1.59, former smokers who have switched to e-cigarettes at 2.54, and those who use both at 2.91. Factors weighed in this ratio included frequency of use; demographic factors; hypertension, diabetes, and cholesterol levels; body mass index; physical activity; and alcohol use.

E-cigarette use by never-smokers is not associated with an increased stroke risk, which is potentially due to relatively young age of sole e-cigarette users with better socioeconomic status, higher insurance enrollment, and normal cardiovascular health that could overall undermine the stroke risk.

Therefore, it remains important to analyze long-term effects of e-cigarette smoking on cerebrovascular metabolism before completely dismissing a higher stroke risk.

This study also did not find any clear benefit from using e-cigarettes if users are switching from combustible cigarette smoking.

Investigators used data from the 2016-2017 Behavior Risk Factor Surveillance System (BRFSS), a national annual, cross-sectional health survey conducted jointly by the Centers for Disease Control and Prevention and all US states and territories to investigate the prevalence and effect of e-cigarette and combustible cigarette use among young adults.

They analyzed responses on cigarette and e-cigarette use from 161,529 participants aged 18-44 years. A slight majority of the sample population was female (53.1 percent), white (50.6 percent), and unmarried (50.3 percent).

Nearly half had annual incomes over $50,000 and just under a quarter identified as Hispanic. Compared with non-smokers, e-cigarette users (solo and concomitantly with smoking) reported higher rates of college dropout / terminal high-school, unmarried status, obesity, and binge drinking.

Although e-cigarettes are labeled by some as a "safer option" to active smoking cessation, nicotine dependence and toxicity remain a great concern in low-risk young adults who smoke e-cigarettes for flavors and fun.

"Consider this study as a wake-up call for young vapers, clinicians, and healthcare policymakers. There is an urgency to regulate such products to avoid economic and population health consequences and a critical need to conduct further research on the benefits and risks of smoking-cessation alternatives," warned Mr. Parekh.