Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health

BACKGROUND: E‐cigarettes are popular for smoking cessation and as an alternative to combustible cigarettes. We assess the association between e‐cigarette use and having had a myocardial infarction (MI) and whether reverse causality can explain the observed cross‐sectional association between e‐cigarette use and MI. METHODS AND RESULTS: Cross‐sectional analysis of the Population Assessment of Tobacco and Health Wave 1 for association between e‐cigarette use and having had and MI. Longitudinal analysis of Population Assessment of Tobacco and Health Waves 1 and 2 for reverse causality analysis. Logistic regression was performed to determine the associations between e‐cigarette initiation and MI, adjusting for cigarette smoking, demographic and clinical variables. Every‐day (adjusted odds ratio, 2.25, 95% CI: 1.23–4.11) and some‐day (1.99, 95% CI: 1.11–3.58) e‐cigarette use were independently associated with increased odds of having had an MI with a significant dose‐response (P<0.0005). Odds ratio for daily dual use of both products was 6.64 compared with a never cigarette smoker who never used e‐cigarettes. Having had a myocardial infarction at Wave 1 did not predict e‐cigarette use at Wave 2 (P>0.62), suggesting that reverse causality cannot explain the cross‐sectional association between e‐cigarette use and MI observed at Wave 1. CONCLUSIONS: Some‐day and every‐day e‐cigarette use are associated with increased risk of having had a myocardial infarction, adjusted for combustible cigarette smoking. Effect of e‐cigarettes are similar as conventional cigarette and dual use of e‐cigarettes and conventional cigarettes at the same time is risker than using either product alone.