The cardiovascular toxicity of electronic cigarettes (e-cigarettes) is not well understood, and population data assessing the cardiovascular effects of ecigarette use are sparse.
In the present study, we used nationally representative data to examine the association of cigarette and e-cigarette use behaviors with biomarkers of inflammation and oxidative stress. Inflammation and oxidative stress are key contributors of smoking-induced cardiovascular disease, and related biomarkers have been studied as predictive factors for cardiovascular events.
The PATH study (Population Assessment of Tobacco and Health) is a nationally representative longitudinal cohort in the United States. The Wave 1 survey
was administered from 2013 to 2014 and included the collection of blood and
urine samples. Additional information on PATH biospecimen procedures is given
Our analysis was restricted to Wave 1 adults ≥18 years of age with
nonmissing data on biomarkers and cigarette/e-cigarette use. Analytic sample sizes
were dependent on the respective biomarker considered.
We classified participants into 4 categories based on cigarette/e-cigarette use
behaviors in the past 30 days to assess product exposure: (1) Nonuse included
respondents with no cigarette or e-cigarette use; (2) exclusive e-cigarette included
individuals with no cigarette use but e-cigarette use; (3) exclusive cigarette included individuals with cigarette use but no e-cigarette use; and (4) dual use included
individuals with e-cigarette and cigarette use.
We selected biomarkers of inflammation (high-sensitivity C-reactive protein,
interleukin-6, fibrinogen, soluble intercellular adhesion molecule) and oxidative
stress (urinary 8-isoprostane) as dependent variables. We used the PATH imputed
biomarker variables in which observations under the limit of detection were replaced by limit of detection/√2. All biomarkers were right skewed and thus loge
transformed for analyses.
Andrew C. Stokes, Et al. – Circulation – January 4, 2021.