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Stroke Risk Nearly Triples with Dual Vaping, Combustible Cigarette Use


A new study found a significant association between increased stroke risk and dual use of e-cigarettes and traditional cigarettes-authors urging physicians to use results as a wake-up call.

US adults who smoke e-cigarettes and traditional combustible cigarettes are nearly 3 times more likely to have a stroke vs non-smokers and nearly 2 times more likely vs sole combustible cigarette users, according to a new cross-sectional study in the American Journal of Preventive Medicine (AJPM).

“This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative. We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and it’s not good,” said lead author Tarang Parekh, MBBS, MSc, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, in an AJPM press release.

Using data from the 2016-2017 Behavior Risk Factor Surveillance System, researchers analyzed responses from >160 000 participants aged 18-44 years (women, 53.1%; white, 50.6%). The majority of current sole e-cigarette users (68.9%) were aged 18-24 years and 47.2% of current sole combustible cigarette users were aged 35-44 years.

Adjusted odds ratio (AOR) for cerebrovascular events (vs nonsmokers) were calculated at: 

• Sole combustible cigarette users: 1.59 (95% confidence interval [CI]=1.14-2.22)
• Former combustible cigarette smokers who switched to e-cigarettes: 2.54 (95% CI=1.16-5.56)
• E-cigarette and combustible cigarette users: 2.91 (95% CI=1.62-5.25)

Sole e-cigarette use was not significantly associated with stroke risk vs non-smoking (AOR=0.69, 95% CI=0.34-1.42). The odds of stroke were lower, however, among sole e-cigarette users vs sole combustible cigarette users (AOR=0.43, 95% CI=0.20-0.93), which may be due to the younger age of vape-only users along with their lower health risk, higher insurance enrollment, and normal cardiovascular health.

Researchers also assessed if it is beneficial for traditional combustible cigarette users to switch to e-cigarettes by testing for differences between current sole combustible cigarette use and current e-cigarette use with prior combustible cigarette use, but found no statistically significant difference.

Vaping may still be widely considered a “safer” alternative to combustible cigarettes, but with the rise in vaping-related lung injuries, Parekh urged physicians to consider this study a wake-up call.

“There is an urgency to regulate such products to avoid economic and population health consequences and a critical need to conduct further research on the benefits and risks of smoking cessation alternatives,” said Parekh in the AJPM press release.

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