Risk of Early Stroke Increased in Adults who Vape vs Smoke Traditional Cigarettes, Study Finds

Adults who use e-cigarettes may be at risk for stroke at an age at least 10 years younger than those who smoke traditional cigarettes, according to new research.

The study, which will be presented during the American Heart Association (AHA) Scientific Sessions 2021 found that although stroke was more prevalent among combustible tobacco smokers, e-cigarette users had a 15% higher risk of a cerebrovascular event at a younger age, ie, at a median average age of 48 years for a first stroke among e-cigarette users vs age 59 years for traditional cigarette users, according to the study abstract.

For those who used both electronic and traditional cigarettes, study authors report, the average age for a first stroke was 50 years.

“The public needs to know that the safety of e-cigarettes have [sic] not been proved," said study co-lead author Urvish K. Patel, MD, MPH, research scholar and chief education officer in the department of public health and neurology at the Icahn School of Medicine at Mount Sinai in an AHA statement. New York City. E-cigarettes "should not be considered as an alternative to traditional smoking especially among people with existing risk factors such as history of heart attack, high blood pressure and high cholesterol."

As context for their study, Patel et al observe that use of tobacco is a known risk factor for stroke and other cardiovascular disease but that the relationship between e-cigarettes and stroke in particular is largely unknown.

To help expand the base of knowledge about a potential association, investigators used National Health and Nutrition Examination Survey data from 2015 to 2018 to identify adults aged 18 years or older who had a history of stroke as well as their smoking habits. A total of 79 825 fit these criteria. Among them, 7,756 (9.72%) used e-cigarettes; 48 625 (60.91%) used traditional cigarettes; and 23 444 (29.37%) used both.

Results

When data were examined further, authors report, the overall prevalence of stroke was 5.41% with prevalence in specific smoking categories found higher among traditional smokers vs both e-cigarette and dual smokers (6.75% vs. 1.09% vs. 3.72%, respectively; p<.001). Compared with traditional smokers and those using both products, those using e-cigarettes were younger at first occurrence of stroke--median age 48 vs 50 vs 59 years, respectively; p<.001, according to the study abstract.

Within subgroups of participants, the researchers found that e-cigarette use was more common among women who experienced stroke (36.36%) than among those reporting traditional cigarette use (33.91%; p<.001).

They observed also that e-cigarette use was more common than traditional tobacco use among Mexican American participants (21.21% and 6.02%) and among non-Mexican American Hispanic participants (24.24% and 7.7%).

In multivariable logistic regression analysis, the odds of having a history of stroke were higher among e-cigarette users compared to traditional smokers (adjusted odds ratio:1.15; 95% confidence interval: 1.15-1.16; p<.001)

Young adults at high risk

Chemicals other than nicotine found in both electronic and traditional tobacco products reduce blood vessel strength, predisposing the environment to clot formation and further blood vessel damage over time and increases risk for both ischemic and hemorrhagic stroke, said Karen L. Furie, MD, MPH, an AHA volunteer expert and chair of the Department of Neurology at Brown University's Warren Alpert Medical School, in the AHA statement. “It's quite possible that exposure at a younger age may cause irreversible damage to blood vessels throughout the body and particularly in the brain,” added Furie. “I think it's important that young people understand that e-cigarettes are not a safe alternative.”

“These findings have clear implications for physicians, health care policymakers and tobacco product regulatory authorities who are advocating for new regulations on e-cigarette access, sales and marketing,” said co-lead author, Neel Patel, MD, a research scholar in the department of public health at the Icahn School of Medicine at Mount Sinai in New York City. “People need to be warned that e-cigarettes should not be promoted as an alternative option to smoking traditional, combustible cigarettes.”

A limitation to the study, notes the AHA statement, is the absence of data on type or severity of strokes experienced.

More prospective studies are needed, the authors say, to better evaluate the long-term effects and safety of e-cigarettes and to mitigate the potential for cardio- and cerebrovascular disorders.

Reference: Patel N, Patel U, Khurana M, et al. Relationship between e-cigarette smoking and stroke – a NHANES study. Presented at the American Heart Association Scientific Sessions 2021, November 13-15, 2021, held online.