Time-varying association between cigarette and ENDS use on incident hypertension among US adults: A prospective longitudinal study

Authors

Steven Cook, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA cookstev@umich.edu.Follow
Jana L. Hirschtick, Advocate Aurora HealthFollow
Geoffrey Barnes, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.Follow
Douglas Arenberg, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA.Follow
Irina Bondarenko, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.Follow
Akash Patel, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Evelyn Jiminez Mendoza, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Jihyoun Jeon, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
David Levy, Georgetown University, Washington, DC, USA.
Rafael Meza, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Nancy L. Fleischer, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.

Recommended Citation

Cook S, Hirschtick JL, Barnes G, et al. Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study. BMJ Open. 2023;13(4):e062297. Published 2023 Apr 21. doi:10.1136/bmjopen-2022-062297

Abstract

Objective: Electronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known about their health effects. The aim of the present study was to examine the prospective association between cigarette and ENDS use on self-reported incident hypertension.

Design: Longitudinal cohort study.

Setting: Nationally representative sample of the civilian, non-institutionalised population in the USA.

Participants: 17 539 adults aged 18 or older who participated at follow-up and had no self-reported heart condition or previous diagnosis of hypertension or high cholesterol at baseline.

Measures: We constructed a time-varying tobacco exposure, lagged by one wave, defined as no use, exclusive established use (every day or some days) of ENDS or cigarettes, and dual use. We controlled for demographics (age, sex, race/ethnicity and household income), clinical risk factors (family history of heart attack, obesity, diabetes and binge drinking) and smoking history (cigarette pack-years).

Outcomes: Self-reported incident hypertension diagnosis.

Results: The self-reported incidence of hypertension was 3.7% between wave 2 and wave 5. At baseline, 18.0% (n=5570) of respondents exclusively smoked cigarettes; 1.1% (n=336) exclusively used ENDS; and 1.7% (n=570) were dual users. In adjusted models, exclusive cigarette use was associated with an increased risk of self-reported incident hypertension compared with non-use (adjusted HR (aHR) 1.21, 95% CI 1.06 to 1.38), while exclusive ENDS use (aHR 1.00, 95% CI 0.68 to 1.47) and dual use (aHR 1.15, 95% CI 0.87 to 1.52) were not.

Conclusions: We found that smoking increased the risk of self-reported hypertension, but ENDS use did not. These results highlight the importance of using prospective longitudinal data to examine the health effects of ENDS use.

Document Type

Article

PubMed ID

37085311