E-Cigarettes Tied to Heart Failure

Use of electronic nicotine products was associated with incident heart failure, a prospective study found.

People who self-reported ever having used electronic cigarettes (e-cigarettes) were 19% more likely to develop heart failure within 45 months than those who reportedly never did (adjusted HR 1.19, 95% CI 1.06-1.35). This was not affected by factors such as patient age, patient sex, and cigarette smoking, reported Yakubu Bene-Alhasan, MD, of MedStar Health in Baltimore, Maryland, and co-authors.

Ever-users had a 21% greater risk of heart failure with preserved ejection fraction (HFpEF) compared with non-users (adjusted HR 1.21, 95% CI 1.01-1.47), but no significant change in risk of heart failure with reduced ejection fraction (HFrEF; adjusted HR 1.11, 95% CI 0.90-1.37).

Patients who were dual users of both e-cigarettes and traditional combustible cigarettes had a 59% increased risk of developing heart failure, according to data from the NIH-funded All of Us research program. These findings will be presented as a poster at the American College of Cardiology meeting this weekend.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” said Bene-Alhasan in a press release. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

Indeed, e-cigarettes have been linked to worse myocardial endothelial function and microvascular function, though the evidence for them triggering more cardiovascular events is not consistent.

Bene-Alhasan pushed back against the idea that e-cigarettes or vapes could be used as a smoking cessation tool, stating that there are a notable number of participants who continue to smoke despite taking up vaping. E-cigarettes are not an officially recommended smoking cessation tool, as the CDC recommends medication and counseling instead.

Study authors noted that the observational nature of the study limited their ability to confirm a causal relationship between e-cigarette use and heart failure, and encouraged further research.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” said Bene-Alhasan. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

Researchers discouraged the use of e-cigarettes in the meantime, particularly among youth.

The study utilized electronic health records from adults in the All of Us program that aims to have 1 million participants from a wide array of backgrounds. Researchers utilized a Population Assessment of Tobacco and Health-styled questionnaires to determine a patient’s nicotine and tobacco use.

The present analysis counted 175,667 participants after excluding those with a documented history of heart failure and missing relevant health data. The average participant was 52 years old and the cohort was 60.5% women. White people made up 70% of the group, and Black people approximately 20%.

Among the 147,007 patients who never used electronic cigarettes, 64.4% had never smoked traditional cigarettes, 20.5% were former smokers, and 15.1% were current smokers.

For the 28,660 people identified as ever-users of e-cigarettes, 31.7% had reportedly never smoked, 39.1% were former smokers, and 29.2% were current smokers.