E-cigarettes concern over heightened stroke risk

There are new warnings that adults who used electronic cigarettes run a higher risk of having a stoke at a younger age than those who smoke traditional tobacco products.

Preliminary research to be presented at the American Heart Association’s (AHA) Scientific Sessions 2021, later this week will highlight those who use e-cigarettes had a 15% higher risk of having a stroke at a younger age when compared with adults who smoked traditional combustible cigarettes and despite the high risk of stroke with tobacco smoking.

The AHA study said tobacco smoking is a known major risk factor for stroke and heart attack and cigarette smoking claims nearly 480,000 lives prematurely every year in the US.

The American Heart Association’s Presidential Advisory, New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention, warned global use of e-cigarettes, which are battery-powered devices that deliver nicotine along with other chemicals in the form of an aerosol, has substantially increased in recent years. However, there is very limited knowledge about the safety, risks and potential efficacy of e-cigarettes to help people quit smoking.

To learn more about the cerebrovascular impact of e-cigarette use, researchers examined National Health and Nutrition Examination Survey from 2015 to 2018 to identify 79,825 adults with a history of stroke who used traditional cigarettes or e-cigarettes. Among the participants, 7,756 (9.72%) used e-cigarettes; 48,625 (60.91%) used traditional cigarettes; and 23,444 (39.37%) used both.

Researchers found that although stroke was more prevalent among traditional cigarette smokers, e-cigarette smokers had a 15% higher risk of having a stroke at a younger age.

“The public needs to know that the safety of e-cigarettes have not been proved to be safe and 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,” said the study’s co-lead author Urvish K. Patel, research scholar and chief education officer in the department of public health and neurology at the Icahn School of Medicine at Mount Sinai in New York City.

“Many people are aware that nicotine is a chemical in vaping products as well as in conventional cigarettes, however, there are lots of other chemicals included that can directly affect the lining of the blood vessels. These can cause damage to the blood vessels that results in atherosclerosis, but it can also cause injury that weakens the strength of the blood vessels, predisposes to clot formation and can damage the blood vessels over time, so that individuals are at risk for both the ischemic and haemorrhagic stroke,” said Karen L. Furie, an American Heart Association volunteer expert and chair of the Department of Neurology at Brown University’s Warren Alpert Medical School in Providence, Rhode Island. “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. I think it’s important that young people understand that e-cigarettes are not a safe alternative, and that the best way to preserve brain health and prevent stroke is to avoid all cigarettes and nicotine products.”

The analysis found adults who used e-cigarettes were younger when they had their first stroke – at a median average age of 48 years, compared to 59 years of age for people who smoked traditional cigarettes and 50 years of age for those who used both.

Strokes was far more common among traditional cigarette smokers than e-cigarette users or people who used both, 6.75% compared to 1.09% and 3.72%, respectively.

“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, M.D., 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 is that researchers did not have data on the type or severity of the participants’ strokes.

“There is still much to learn about why e-cigarette use is linked to younger age for first stroke,” the AHA added. “Researchers said more research is needed to better evaluate the long-term effects of e-cigarettes and their role in heart and stroke health.”

To learn more about the cerebrovascular impact of e-cigarette use, researchers examined National Health and Nutrition Examination Survey from 2015 to 2018 to identify 79,825 adults with a history of stroke who used traditional cigarettes or e-cigarettes. Among the participants, 7,756 (9.72%) used e-cigarettes; 48,625 (60.91%) used traditional cigarettes; and 23,444 (39.37%) used both.

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