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      Electronic Cigarette Prevalence and Patterns of Use in Adults with a History of Cardiovascular Disease in the United States

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          Abstract

          Background

          Characterizing electronic cigarette (e‐cigarette) use patterns is important for guiding tobacco regulatory policy and projecting the future burden of tobacco‐related diseases. Few studies have examined patterns of e‐cigarette use in individuals with cardiovascular disease ( CVD).

          Methods and Results

          We examined e‐cigarette use in adults aged 18 to 89 years with a history of CVD, using data from the 2014 National Health Interview Survey. We investigated associations between ever and current e‐cigarette use and smoking with multivariable logistic regression. In a secondary analysis, we modeled the association between e‐cigarette use and a quit attempt over the past year. Former smokers with CVD who quit smoking within the past year showed 1.85 (95% confidence interval, 1.03, 3.33) times the odds of having ever used e‐cigarettes as compared with those who reported being “some days” current smokers. Current smokers who attempted to quit smoking within the past year showed significantly increased odds of ever having used e‐cigarettes (odds ratio, 1.70; 95% confidence interval, 1.25, 2.30) and currently using e‐cigarettes (odds ratio, 1.97; 95% confidence interval, 1.32, 2.95) as compared with smokers who had not attempted to quit over the past year.

          Conclusions

          Individuals with CVD who recently quit smoking or reported a recent quit attempt were significantly more likely to use e‐cigarettes than current smokers and those who did not report a quit attempt. Our findings may indicate that this population is using e‐cigarettes as an aid to smoking cessation. Characterizing emerging e‐cigarette use behaviors in adults with CVD may help to inform outreach activities aimed at this high‐risk population.

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          Most cited references30

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          Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.

          Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p 21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.
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            Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.

            As more interventions become available for the treatment of coronary heart disease (CHD), policy makers and health practitioners need to understand the benefits of each intervention, to better determine where to focus resources. This is particularly true when a patient with CHD quits smoking. To conduct a systematic review to determine the magnitude of risk reduction achieved by smoking cessation in patients with CHD. Nine electronic databases were searched from start of database to April 2003, supplemented by cross-checking references, contact with experts, and with large international cohort studies (identified by the Prospective Studies Collaboration). Prospective cohort studies of patients who were diagnosed with CHD were included if they reported all-cause mortality and had at least 2 years of follow-up. Smoking status had to be measured after CHD diagnosis to ascertain quitting. Two reviewers independently assessed studies to determine eligibility, quality assessment of studies, and results, and independently carried out data extraction using a prepiloted, standardized form. From the literature search, 665 publications were screened and 20 studies were included. Results showed a 36% reduction in crude relative risk (RR) of mortality for patients with CHD who quit compared with those who continued smoking (RR, 0.64; 95% confidence interval [CI], 0.58-0.71). Results from individual studies did not vary greatly despite many differences in patient characteristics, such as age, sex, type of CHD, and the years in which studies took place. Adjusted risk estimates did not differ substantially from crude estimates. Many studies did not adequately address quality issues, such as control of confounding, and misclassification of smoking status. However, restriction to 6 higher-quality studies had little effect on the estimate (RR, 0.71; 95% CI, 0.65-0.77). Few studies included large numbers of elderly persons, women, ethnic minorities, or patients from developing countries. Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD. This risk reduction appears to be consistent regardless of age, sex, index cardiac event, country, and year of study commencement.
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              A systematic review of health effects of electronic cigarettes.

              To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs). Search in: PubMed, EMBASE and CINAHL. Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible. We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in conventional cigarettes, e.g. propylene glycol. Experimental studies found increased airway resistance after short-term exposure. Reports on short-term adverse events were often flawed by selection bias. Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless. Copyright © 2014. Published by Elsevier Inc.
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                Author and article information

                Contributors
                acstokes@bu.edu
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                26 April 2018
                01 May 2018
                : 7
                : 9 ( doiID: 10.1002/jah3.2018.7.issue-9 )
                : e007602
                Affiliations
                [ 1 ] Department of Global Health Boston University School of Public Health Boston MA
                [ 2 ] Department of Epidemiology & Prevention Wake Forest School of Medicine Winston‐Salem NC
                [ 3 ] Department of Medicine Boston University School of Medicine Boston MA
                [ 4 ] Department of Community Health Sciences Boston University School of Public Health Boston MA
                [ 5 ] Department of Epidemiology Boston University School of Public Health Boston MA
                Author notes
                [*] [* ] Correspondence to: Andrew Stokes, PhD, Boston University School of Public Health, 801 Massachusetts Ave 3rd Floor, 362, Boston, MA 02118. E‐mail: acstokes@ 123456bu.edu
                Article
                JAH33071
                10.1161/JAHA.117.007602
                6015295
                29700041
                cc260e88-abed-4f3b-889e-95c0ed2b56be
                © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 13 September 2017
                : 20 February 2018
                Page count
                Figures: 1, Tables: 4, Pages: 10, Words: 7248
                Funding
                Funded by: National Heart, Lung, and Blood Institute of the National Institutes of Health
                Funded by: Center for Tobacco Products
                Award ID: P50HL120163
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                jah33071
                01 May 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.7.2 mode:remove_FC converted:01.05.2018

                Cardiovascular Medicine
                cardiovascular disease,e‐cigarettes,epidemiology,smoking,smoking cessation,lifestyle

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