In the late 1960s, the Public Health Cigarette Smoking Act was introduced by Congress, requiring written warnings to be placed on the side of cigarette packs. Despite aggressive opposition from the tobacco industry, in the mid-1980s, graphic health warnings were first introduced and slowly diffused into tobacco marketing campaigns over the next few decades. The dangers of smoking tobacco cigarettes are no secret. Most of us remember the graphic imagery of anti-smoking ads depicting black lungs and stomas. 20% of deaths in the US each year are related to cigarette smoking and exposure to second-hand smoke. However, much is still unknown about the newer e-cigarette alternative to smoking tobacco and its effects on our health, particularly when it comes to cardiovascular disease (CVD).
Although cross-sectional studies have evaluated the impact of e-cigarette use and CVD, these studies are limited in that they only collect data at one point in time. Longitudinal studies, which continually collect data over an extended period, are needed to understand the relationship between e-cigarette use and risk. In May 2022, one such longitudinal study evaluated over 24,000 eligible participants who either exclusively used e-cigarettes or were dual users of both e-cigarettes and traditional cigarettes. Self-reported data were collected from 2013 to 2019 and adjusted for covariates such as other CVD risk factors, age, ethnicity, and education level. The analysis demonstrated that CVD risk in those exclusively using e-cigarettes did not differ from non-users. However, exclusive e-cigarette users were found to have a nonsignificant increase in stroke, heart failure, and heart attack risk. Those who used both e-cigarettes and traditional cigarettes did not differ significantly in risk from those who exclusively smoked traditional cigarettes.
Although these results appear promising for e-cigarette users, significant limitations of this study include the short follow-up period. In addition, the fact that data was self-reported introduces the risk of bias. Larger studies with a longer follow-up period will be required to understand risk further and develop more robust health guidelines around the use of e-cigarettes. Importantly, however, it was found that combining traditional cigarettes with e-cigarette use does not reduce CVD risk. Therefore, the optimal strategy given available evidence for mitigating CVD risk includes quitting both products.