E-Cigarette Use Rebounds in Patients with CVD After Initial Decline, Study Finds


Trends show e-cigarette use in patients with CVD decreased from 2015 to 2019, but rebounded in 2019, potentially owing to the COVID-19 pandemic.

Electronic cigarettes laboratory testing | Image Credit: CDC

Credit: CDC

New research indicated electronic cigarette use in patients with cardiovascular disease (CVD) decreased over a period from 2015 to 2019, possibly reflecting the reported harms of e-cigarette use in recent years.1

However, the analysis revealed e-cigarette use rebounded in 2019, with a noted increase among young individuals and women, while many with CVD were likely to use e-cigarettes as a smoking cessation tool.

“E-cigarettes may help control tobacco consumption, but whether the replacement of traditional cigarettes with e-cigarettes helps smokers improve cardiovascular health needs further verification,” wrote the investigative team, led by Shanjie Wang, MD, PhD, department of cardiology, Second Affiliated Hospital of Harbin Medical University and Yiying Zhang, MD, PhD, department of epidemiology and biostatistics, Jiamusi University.

The investigative team performed a cross-sectional study to assess the trends of e-cigarette use among adults with CVD and help understand the future management of its use. Data were analyzed from January to March 2023.

Tobacco use is well-established as a substantial contributor to the increased disease burden associated with cardiovascular disease, leading to a considerable reduction in life expectancy of approximately 10 years. E-cigarettes have garnered notable popularity since entering the market in 2006 as a potential aid for smoking cessation.2 Importantly, the use of e-cigarettes has been associated with increased adverse cardiovascular events.

Study participants were aged 18 years or older and responded to the annual cross-sectional National Health Interview Survey between 2014 and 2020. Participants self-reported race and ethnicity were analyzed to determine differences in e-cigarette use. The study additionally estimated the prevalence of self-reported e-cigarette use, stratified by age, sex, and smoking status.

A total of 30,465 participants were included in the study, with a mean age of 65 years. Of the population, 15,442 were women (47.8%), 1302 identified as Asian (1.6%), 3653 identified as Black (4.9%), 2443 identified as Hispanic, and the rest identified as White (84.7%).

Upon analysis, the investigative team found the weight prevalence of current e-cigarette use decreased from 5.2% in 2014 to 3.1% in 2019 but subsequently bounced back to 5.2% in 2020. E-cigarette use among patients with CVD who quit smoking experienced an increase from 3.2% in 2015 to 10.1% in 2020.

For individuals aged 60 years or older, e-cigarette use decreased from 2.9% in 2014 to 0.9% in 2020. On the other, the use in those younger than 60 years remained high at 6.2% in 2014 to 7.2% in 2020. The analysis found men were more likely to use e-cigarettes than women before 2018, but the trend was reversed in 2019 and 2020 (2.9% for men vs. 8.3% for women).

In comparison to current combustible smokers, individuals who had quit combustible tobacco (odds ratio [OR], 1.8; 95% CI, 1.2 - 2.7) and those who had tried, but failed to quit tobacco in the past year (OR, 2.0; 95% CI, 1.5 - 2.6) were more likely to use e-cigarettes.

Investigators noted smoking cessation, rather than e-cigarette substitution, might be a more beneficial option for cardiovascular secondary prevention.

“Although our study was limited by self-reporting, e-cigarette use among patients with a history of CVD is noteworthy, especially among younger individuals and women and ex-smokers,” investigators wrote.

Further studies may help to understand the cardiovascular effects of e-cigarettes compared with combustible tobacco and inform future legislation for improvements in cardiovascular health.


  1. Wen X, Xia T, Li R, et al. Trends in Electronic Cigarette Use Among US Adults With a History of Cardiovascular Disease. JAMA Netw Open. 2023;6(8):e2328962. doi:10.1001/jamanetworkopen.2023.28962
  2. Hajek P, Phillips-Waller A, Przulj D, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629-637. doi:10.1056/NEJMoa1808779

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