Former smokers who switch to e-cigarettes two times more likely to have a stroke, finds study
Current users of e-cigarettes who used to smoke cigarettes earlier are more than twice as likely to have a stroke, which shows that vaping may not be a safe way to quit smoking.
This is according to a new study by researchers from George Mason University, US; Franconia Pediatrics Associates, Alexandria, Virginia; and Atlanta VA Medical Center, Decatur, Georgia.
The team also found that young adults who smoke cigarettes, as well as 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.
According to the lead investigator of the study, Dr. Tarang Parekh from the Department of Health Administration and Policy, George Mason University, this is an important message for young smokers who perceive e-cigarettes as less harmful.
"Compared with non-smokers, the adjusted odds ratio for stroke among those with current sole combustible cigarette use was 1.59. Current e-cigarette users, who were former combustible cigarette users had an adjusted odds ratio of 2.54," says the study.
"The odds were 2.91 times higher in current dual users versus non-smokers. Current dual use of e-cigarettes and combustible cigarettes was associated with 1.83 times higher odds versus current sole combustible cigarette users," adds the study published in the American Journal of Preventive Medicine.
Factors weighed in this ratio included frequency of use, demographic factors, hypertension, diabetes, cholesterol levels, body mass index, physical activity, and alcohol use.
Dr. Parekh says it has long been known that smoking cigarettes is among the most significant risk factors for stroke. But the current study shows that young smokers, who also use e-cigarettes, are putting themselves at even greater risk, he says.
The increased risk of stroke in current e-cigarette users, who were former or current combustible cigarette users, indicates an additive harmful effect of e-cigarettes on smokers' blood vessels, hearts, and brains, says the team.
"We already have established fact the combustible cigarette is a risk factor for stroke. However, to our knowledge, it is the first nationwide study to report the association between stroke and concomitant use of e-cigarettes and its switching benefits," Dr. Parekh tells MEA WorldWide (MEAWW).
"E-cigarettes could have an additive effect that may lead to stroke at a younger age. While people are looking at e-cigarettes as a healthy alternative to cigarettes, at the same time, now have emerging evidence of adverse effects of e-cigarettes," he shares.
He adds, "In this current discussion, we found no conclusive evidence of switching benefits from cigarette to e-cigarette in terms of stroke. Abstinence would be the safe choice until further investigation."
There is an ongoing investigation in the US by the Centers for Disease Control and Prevention (CDC) after the outbreak of lung injury associated with the use of e-cigarette or vaping products.
As of December 27, 2019, 2,561 hospitalized cases or deaths have been reported to CDC from all 50 states. Fifty-five deaths have been confirmed, says CDC.
However, according to a recent survey of 1,800 Americans (aged 18-38 years) by Harmony Healthcare IT, 77% said they believe vaping is healthier than smoking cigarettes and 60% think it is healthier than drinking alcohol.
The current analysis included 161,529 participants aged 18-44 years. The researchers 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.
Compared with non-smoking, current sole e-cigarette-use and current dual-use were associated with higher rates of college dropout or high school graduation, unmarried status, obesity, and binge drinking, says the study.
According to the analysis, compared with current sole combustible cigarette users, current sole e-cigarette users had lower odds of stroke. But the study did not find any clear benefit from using e-cigarettes if users are switching from combustible cigarette smoking.
“Sole e-cigarette use is not associated with greater odds of stroke in young adults. However, if young adults have former or current combustible cigarette use, odds of stroke are significantly increased even compared with current sole combustible cigarette use. Switching from combustible cigarette smoking to e-cigarette use did not curtail the risk of stroke in young adults,” the findings state.
Researchers say that e-cigarette use by never-smokers is not associated with an increased stroke risk, which is potentially due to the relatively young age of sole e-cigarette users with better socio-economic status, higher insurance enrollment, and normal cardiovascular health that could overall undermine the stroke risk.
Therefore, it is important to analyze the long-term effects of e-cigarette smoking on before completely dismissing a higher stroke risk, they say.
Experts say though e-cigarettes are labeled by some as a "safer option" to people who want to stop smoking, "nicotine dependence and toxicity remain a great concern in low-risk young adults who smoke e-cigarettes for flavors and fun."
Based on their findings, researchers recommend further studies to understand the benefits and risks of current alternatives to quit smoking.