Cardiovascular Outcomes among Combustible-Tobacco and Electronic Nicotine Delivery System (ENDS) Users in Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) Study, 2013–2019

Martin C. Mahoney, Cheryl Rivard, Heather L. Kimmel, Hoda T. Hammad, Eva Sharma, Michael J. Halenar, Jim Sargent, K. Michael Cummings, Ray Niaura, Maciej L. Goniewicz, Maansi Bansal-Travers, Dorothy Hatsukami, Diann Gaalema, Geoffrey Fong, Shannon Gravely, Carol H. Christensen, Ryan Haskins, Marushka L. Silveira, Carlos Blanco, Wilson Compton, Cassandra A. Stanton and Andrew Hyland
Additional contact information
Martin C. Mahoney: Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
Cheryl Rivard: Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
Heather L. Kimmel: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA
Hoda T. Hammad: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
Eva Sharma: Westat, Rockville, MD 20850, USA
Michael J. Halenar: Westat, Rockville, MD 20850, USA
Jim Sargent: The C. Everette Koop Institute at Dartmouth, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
K. Michael Cummings: Medical University of South Carolina, Charleston, SC 29425, USA
Ray Niaura: NYU School of Global Public Health, New York, NY 10003, USA
Maciej L. Goniewicz: Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
Maansi Bansal-Travers: Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
Dorothy Hatsukami: University of Minnesota, Minneapolis, MN 55414, USA
Diann Gaalema: University of Vermont, Burlington, VT 05404, USA
Geoffrey Fong: University of Waterloo, Waterloo, ON N2L 3G1, Canada
Shannon Gravely: University of Waterloo, Waterloo, ON N2L 3G1, Canada
Carol H. Christensen: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
Ryan Haskins: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
Marushka L. Silveira: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA
Carlos Blanco: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA
Wilson Compton: National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA
Cassandra A. Stanton: Westat, Rockville, MD 20850, USA
Andrew Hyland: Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA

IJERPH, 2022, vol. 19, issue 7, 1-10

Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords: tobacco use; cardiovascular disease; health survey; electronic nicotine delivery systems (ENDS); electronic cigarette (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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