Longitudinal associations Between Exclusive and Dual Use of Electronic Nicotine Delivery Systems and Cigarettes and Self-Reported Incident Diagnosed Cardiovascular Disease among adults.

Introduction:
This text provides an analysis of a study examining the prospective associations between exclusive and dual use of electronic nicotine delivery systems (ENDS) and cigarettes and self-reported incident diagnosed myocardial infarction (MI) and stroke among adults in the United States. The study aims to assess the risks associated with ENDS use and situate them within the risk continuum of nicotine and tobacco products, characterizing risks for people who do not smoke cigarettes. The analysis uses data from Waves 1-5 of the Population assessment of Tobacco and health (PaTh) Study, a nationally representative longitudinal study of the U.S. civilian, non-institutionalized population ages 12 and older.

Key Points:

* The study uses a longitudinal, nationally representative study design and adjusts for past cigarette smoking history.
* The analysis focuses on self-reported diagnosed MI and stroke as outcomes.
* The study defines ENDS use as established current use every day or some days and cigarette use as established current use every day or some days.
* The exposure variable is a four-category variable that includes non-current use of either product, exclusive cigarette use, exclusive ENDS use, or dual use of cigarettes and ENDS.
* The study lags the exposure variable by one wave and evaluates its association with the corresponding outcome at that wave.
* The study controls for age, sex, race/ethnicity, educational attainment, family history of premature heart disease, diagnosed hypertension, and diagnosed diabetes.
* The study also adjusts for historical cigarette smoking by including indicators for former established smoking and cigarette pack-years for adults who currently/formerly smoke cigarettes.

Main Message:
The study finds that exclusive cigarette use is associated with an increased risk of self-reported incident diagnosed MI and stroke over a 5-year period. however, ENDS use, either exclusively or in combination with cigarettes, is not statistically associated with increased risk of self-reported incident diagnosed MI or stroke. The study emphasizes the importance of accounting for smoking history when assessing the independent health effects of ENDS use on cardiovascular disease. The harm reducing potential of switching from cigarettes to ENDS requires further study, but the well-known harm producing effect of continued cigarette use on cardiovascular health has been re-affirmed in the study. Convincing adults who smoke cigarettes to stop smoking remains an important public health challenge with clear implications for cardiovascular health.

hirschtick JL, Cook S, Patel a, et al. Longitudinal associations Between Exclusive and Dual Use of Electronic Nicotine Delivery Systems and Cigarettes and Self-Reported Incident Diagnosed Cardiovascular Disease among adults. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2023;25(3):386-394. doi:10.1093/ntr/ntac182