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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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          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.


          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 references 38

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          Heart disease and stroke statistics--2013 update: a report from the American Heart Association.

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            The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.

            Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.
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              AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation.


                Author and article information

                J Am Heart Assoc
                J Am Heart Assoc
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                26 April 2018
                01 May 2018
                : 7
                : 9 ( doiID: 10.1002/jah3.2018.7.issue-9 )
                [ 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@
                © 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 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.

                Page count
                Figures: 1, Tables: 4, Pages: 10, Words: 7248
                Funded by: National Heart, Lung, and Blood Institute of the National Institutes of Health
                Funded by: Center for Tobacco Products
                Award ID: P50HL120163
                Original Research
                Original Research
                Custom metadata
                01 May 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version= mode:remove_FC converted:01.05.2018


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