Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA.
Int J Environ Res Public Health. 2022 Mar 31;19(7):4137. doi: 10.3390/ijerph19074137.
Prior studies have not clearly established risk of cardiovascular disease (CVD) among smokers who switch to exclusive use of electronic nicotine delivery systems (ENDS). We compared cardiovascular disease incidence in combustible-tobacco users, those who transitioned to ENDS use, and those who quit tobacco with never tobacco users.
This prospective cohort study analyzes five waves of Population Assessment of Tobacco and Health (PATH) Study data, Wave 1 (2013-2014) through Wave 5 (2018-2019). Cardiovascular disease (CVD) incidence was captured over three intervals (Waves 1 to 3, Waves 2 to 4, and Waves 3 to 5). Participants were adults (40+ years old) without a history of CVD for the first two waves of any interval. Change in tobacco use status, from exclusive past 30 day use of any combustible-tobacco product to either exclusive past 30 day ENDS use, dual past 30 day use of ENDS and combustible-tobacco, or no past 30 day use of any tobacco, between the first two waves of an interval was used to predict onset of CVD between the second and third waves in the interval. CVD incidence was defined as a new self-report of being told by a health professional that they had congestive heart failure, stroke, or a myocardial infarction. Generalized estimating equation (GEE) analyses combined 10,548 observations across intervals from 7820 eligible respondents.
Overall, there were 191 observations of CVD among 10,548 total observations (1.7%, standard error (SE) = 0.2), with 40 among 3014 never users of tobacco (1.5%, SE = 0.3). In multivariable models, CVD incidence was not significantly different for any tobacco user groups compared to never users. There were 126 observations of CVD among 6263 continuing exclusive combustible-tobacco users (adjusted odds ratio [AOR] = 1.44; 95% confidence interval (CI) 0.87-2.39), 15 observations of CVD among 565 who transitioned to dual use (AOR = 1.85; 0.78-4.37), and 10 observations of CVD among 654 who quit using tobacco (AOR = 1.18; 0.33-4.26). There were no observations of CVD among 53 who transitioned to exclusive ENDS use.
This study found no difference in CVD incidence by tobacco status over three 3 year intervals, even for tobacco quitters. It is possible that additional waves of PATH Study data, combined with information from other large longitudinal cohorts with careful tracking of ENDS use patterns may help to further clarify this relationship.
先前的研究并未明确表明，从使用可燃烟草产品转为使用电子尼古丁传送系统（ENDS）的吸烟者患心血管疾病（CVD）的风险。我们比较了可燃烟草使用者、转向使用ENDS 者和戒烟者的心血管疾病发病率与从不吸烟的人。
本前瞻性队列研究分析了五次人口烟草与健康评估（PATH）研究的数据，第 1 波（2013-2014 年）至第 5 波（2018-2019 年）。通过三个区间（第 1 波至第 3 波、第 2 波至第 4 波和第 3 波至第 5 波）捕捉心血管疾病（CVD）的发病率。参与者为成年人（40 岁以上），且在两个区间的前两个波中没有 CVD 的既往病史。从使用任何可燃烟草产品转为在区间的前两个波之间，过去 30 天内仅使用过某种可燃烟草产品（过去 30 天内唯一使用）、过去 30 天内同时使用 ENDS 和可燃烟草产品（双重使用）或过去 30 天内未使用任何烟草产品的情况变化，用于预测在区间的第二波和第三波之间出现 CVD 的情况。CVD 发病被定义为健康专业人员告知他们患有充血性心力衰竭、中风或心肌梗死的新自我报告。广义估计方程（GEE）分析结合了来自 7820 名合格应答者的 10548 个区间的观察结果。
在 10548 个总观察中，共有 191 例 CVD 观察结果（1.7%，标准误差[SE] = 0.2），其中 40 例来自 3014 名从不吸烟的人（1.5%，SE = 0.3）。在多变量模型中，与从不吸烟的人相比，任何烟草使用者的 CVD 发病率均无显著差异。在继续使用可燃烟草产品的 6263 名吸烟者中，有 126 例 CVD 观察结果（调整后的优势比[AOR] = 1.44；95%置信区间[CI] 0.87-2.39），在转为双重使用者的 565 名吸烟者中，有 15 例 CVD 观察结果（AOR = 1.85；0.78-4.37），在戒烟的 654 名吸烟者中，有 10 例 CVD 观察结果（AOR = 1.18；0.33-4.26）。在转为仅使用 ENDS 的 53 名吸烟者中，没有 CVD 观察结果。
这项研究在三个 3 年区间内没有发现烟草状况与 CVD 发病率之间的差异，即使是吸烟者戒烟后也是如此。可能需要 PATH 研究的更多波次数据，结合其他具有对 ENDS 使用模式进行仔细跟踪的大型纵向队列的信息，可能有助于进一步阐明这种关系。
