Abstract P387: Comparing Cardiovascular Outcomes Among Smokers and E-Cigarette Users: A Review From National Health Interview Surveys
Authors: Mohinder Reddy Vindhyal, Paul Ndunda, Cyrus Munguti, Shravani Vindhyal, Hayrettin Okut
Journal: Circulation (2019)

Background: In 2016 according to the center for disease control (CDC), 11.3% of high school students and 3.2% of US adults reported using electronic cigarettes (E-cigs) in the previous 30 days. E-cigs have been advertised as a safer alternative to smoking. However, E-cig use, like smoking, delivers ultra-small aerosol particles which may be associated with cardiovascular disease. E-cig users have shown similar endothelial dysfunction, aortic stiffness, platelet activation, aggregation, and adhesion as seen with smoking in animal models. Methods: The National Health Interview Survey (NHIS) a survey of people aged 18 years and older, is conducted by the U.S. Census Bureau using in-person interviews in a random sampling of U.S households is conducted by the CDC. This study is a cross-sectional analysis of the NHIS data of 2014 (n= 36,697), 2016 (n=33,028) and 2017(n= 26,742). The following outcomes were analyzed for e-cig users vs. non-users and smoker’s vs. non-smokers: myocardial infarction, hypertension, diabetes, depression/anxiety/emotional problems, circulatory problems, and stroke. For the outcomes, multiple logistic regression model was conducted to determine the covariate-adjusted odds ratio as well as to achieve the most appropriate p-value for the effects in the model. Variables such as age, BMI and sex were considered as covariates in multiple logistic regression models using SAS 9.4 software. Results: Compared with non-E-Cig-users, E-cigarette users had a lower mean age (32.9 vs 40.4 years) and similar BMI (28.1 vs 28.07). In multiple logistic regression analysis, E-Cig users had higher odds of having myocardial infarction [OR - 1.558, 95% CI (1.447, 1.678), P &lt;0.0001], stroke [OR - 1.297, 95% CI (1.201, 1.400), P &lt;0.0001], depression/anxiety/emotional problems [OR- 2.200, 95% CI (2.063, 2.347), P&lt;0.0001] and circulatory problems [ OR - 1.436, 95% CI (1.251, 1.648), P &lt; 0.0001]. E-cig users had lower odds of having diabetes. There was no significant difference between the two groups on the odds of hypertension [OR - 0.971, 95% CI (0.942, 1.001), P = 0.059] and. Smokers had higher odds of myocardial infarction [OR- 2.652, 95% CI (2.516, 2.796), P &lt;0.0001], stroke [OR - 1.781, 95% CI (1.691, 1.875), P &lt;0.0001], depression/anxiety/emotional problems [OR-1.694, 95% CI (1.598, 1.795), P&lt;0.0001], circulatory problems [OR - 1.491, 95% CI (1.338,1.661), P &lt; 0.0001], Hypertension [OR - 1.483, 95% CI (1.452, 1.513), P &lt; 0.0001] and Diabetes [OR - 1.170, 95% CI (1.130, 1.211), P &lt; 0.0001] compared with non-smokers. Conclusion: E-cig users have higher odds of myocardial infarction, stroke, depression/anxiety/emotional problems, circulatory problems (including blood clots) and lower risk of hypertension and diabetes compared to non-E-cigarette users. However, there is a need for cohort studies to establish the causation linkage for the cardiovascular outcomes described above.