US Adult E-Cigarette Use Climbing, Despite Cardiology Health Concerns

Mahmoud Al Rifai, MD, MPH

Electronic cigarette use has grown to approximately 1 in every 20 US adults, according to new findings presented virtually at the American College of Cardiology (ACC) 2020 Scientific Sessions this week.

An assessment of 930,000 surveyed US adults, conducted by Mahmoud Al Rifai, MD, MPH, cardiology fellow at Baylor College of Medicine and colleagues, showed that approximately 29,000 people identified as current e-cigarette users.

Investigators used data from the annual, large-scale phone survey Behavioral Risk Factor Surveillance System (BRFSS)—a four-decade data collection program designed to represent the characteristics and demographics of the US adult population.

Current e-cigarette use was defined as participants indicating they used e-cigarettes daily or on some days. Al Rifai and colleagues compared the 2018 findings—the most recently available data—to those reported in 2016.

When looking at e-cigarette and vaping use among subpopulations, investigators noted particularly greater rates among women (4.3% vs 3.3%), former smokers (7.9% vs 5.2%), and adults aged 45-54 years old (5.2% vs 3.9%).

Current use among people who use smokeless tobacco products nearly doubled in the observed 3 years (16.2% vs 9.2%).

The surveyed population rate from 2018 translated to about 10.8 million total US adults, investigators noted—an increase of a half-percentage point from 2016 results (4.8% vs 4.3%).

Though a three-year jump of just 0.5% may not sound significant, Al Rifai noted it does indicate a great amount of new e-cigarette users relative to the overall US population.

“Based on our findings, I think the trend is only going to go upward, but we don’t know yet what the long-term health effects are,” he said in a statement.

Al Rifai’s belief that such national tends reflect the increased marketing and advertisement of e-cigarette and vaping product makers to young adult audiences is evidenced by findings from earlier this year showing market-leading JUUL products constitute about two-thirds of the increasing annual e-cigarette dollar sales.

A pair of smaller-scale studies being presented virtually by ACC 2020 show potential association between vaping and heart disease. One—a blood sample-based assessment of non-smokers, smokers, and e-cigarette users—showed both e-cigarette and smoke tobacco users are significantly more affected by oxidative stress associated with heart artery plaque buildup than non-smokers.

Holly Middlekauff, MD, UCLA cardiologist and senior study author, said the findings show not only that circulating immune cells report greater oxidative stress in smokers and e-cigarette users, but that there are also more chronic inflammatory cells present.

“Our study suggests there is a continuum of harm, with non-users having the least amount of oxidative stress, electronic cigarette users showing an intermediate level and chronic tobacco smokers having the largest amount of oxidative stress,” Middlekauf noted in a statement.

Al Rifai called on a sense of urgency in conducting further research into the prevalence of vaping and its long-term implication on individual and public health metrics. As he noted, it’s been too soon to tell what that harm may be.

“Because e-cigarettes have only been around for about a decade, many large cohort studies have only just recently started incorporating e-cigarette information into their questionnaires,” he said. “Yet, the cumulative effects of e-cigarettes may take years to develop, especially in the context of cardiovascular disease.”

The study, "Trends in Prevalence of E-Cigarette Use Among U.S. Adults. Behavioral Risk Factor Surveillance System, 2016 And 2017," was presented at ACC 2020.