Abstract
Following their introduction a decade ago, electronic cigarettes (e-cigarettes) have grown in popularity. Given their novelty, knowledge of the health consequences of e-cigarette use remains limited. Epidemiologic studies have not comprehensively explored associations between e-cigarette use and hypertension, a highly prevalent health condition and major contributor to cardiovascular disease burden. In this study, cross-sectional associations of cigarette smoking and e-cigarette use (vaping) with self-reported diagnosed hypertension were evaluated among 19,147 18–55 year old respondents in Wave 3 (2015–2016) of the Population Assessment of Tobacco and Health Study. Multivariable analyses first modeled smoking and vaping as separate 2-category variables, then as a 6-category composite variable accounting for former smoking. After adjusting for potential confounders, current vaping (aOR = 1.31; 95%CI: 1.05–1.63) and current smoking (aOR = 1.27; 95%CI: 1.10–1.47) were both associated with higher odds of hypertension. In analyses modeling smoking and vaping compositely, respondents who were concurrently smoking and vaping had the highest odds of hypertension (aOR = 1.77; 95%CI: 1.32–2.39 [referent: never smokers]). These results differ somewhat from prior epidemiologic studies of vaping and respiratory outcomes, which consistently report smaller point estimates for current vaping than for current smoking. Our findings reinforce the uncertainty surrounding long-term health consequences of vaping, as well as highlight important distinctions between respiratory and cardiovascular outcomes when considering the harm reduction potential of e-cigarettes.
Highlights
Tobacco’s status as a leading cause of preventable disease and premature mortality spans many decades [1]
In light of the detriment caused by smoking tobacco, electronic cigarettes (e-cigarettes) were developed as alternatives to combusted cigarettes in the late 2000s
E-cigarettes encompass a range of devices which heat and aerosolize a solution that typically contains nicotine and a mixture of propylene glycol, glycerin and various flavoring additives
Summary
Tobacco’s status as a leading cause of preventable disease and premature mortality spans many decades [1]. While intense focus from researchers and policy makers has contributed substantially to recent decreases in use [2], tobacco remains a major public health concern: in 2017, an estimated 7.1 million deaths and the loss of 182 million disabilityadjusted life years were attributed to tobacco use across the globe [3]. The vast majority of tobacco-related death and morbidity are caused by smoke from combusted tobacco products [4], which contains numerous cardiovascular toxicants [5]. A seminal publication estimated that 1 in 10 deaths from cardiovascular disease (CVD) could be attributed to tobacco smoking in the year 2000 [6], reinforcing the importance of smoking as a modifiable risk factor in efforts to reduce global burden of CVD. E-cigarettes encompass a range of devices which heat and aerosolize a solution that typically contains nicotine and a mixture of propylene glycol, glycerin and various flavoring additives
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