E-Cigarette Use and Early Cardiovascular Risk in Young Adults

BACKGROUND: Electronic cigarette use, vaping, is common among young adults. The cardiovascular (CV) risk remains unknown. OBJECTIVES: This study evaluated the association of long-term vaping with markers of CV risk in young adults. METHODS: We recruited 372 CV disease-free participants aged 18 to 49 years into 4 groups: vaping/never smoking, vaping/former smoking, vaping/current smoking (dual use), or never vaping/never smoking and measured systolic and diastolic blood pressure (SBP/DBP), endothelial function (Framingham reactive hyperemia index), and coronary artery calcification (CAC) (spatially weighted CAC score). We used multivariable-adjusted linear and log-linear regression to model associations of vaping with markers of CV risk. RESULTS: The median (Q1-Q3) age was 26 (21-33) years, and 50.5% were males. The median (Q1-Q3) years of vaping was 4 (2-6) years. After adjustment for age, gender, education, and body mass index, least squares mean differences (95% CI) for SBP/DBP in mm Hg were 4.79 (1.83-7.75)/2.88 (0.54-5.21), 1.60 (-1.65 to 4.85)/1.44 (-1.12 to 4.00), 1.10 (-1.86 to 4.06)/1.48 (-0.86 to 3.82), respectively, comparing vaping/never smoking, vaping/former smoking, and dual use to never vaping/never smoking. The corresponding least squares mean differences (95% CI) of SBP/DBP for greater than 100 vs fewer than 36 e-cigarette puffs/day were 4.84 (0.94-8.74)/3.57 (0.74-6.41) mm Hg. There was no association between vaping categories and Framingham reactive hyperemia index. For spatially weighted CAC score, there was an inverse association for the 3 vaping categories vs never vaping/never smoking. CONCLUSIONS: Long-term vaping in young adults was associated with higher blood pressure, with evidence of a dose-response by vaping intensity. Vaping alone or vaping plus smoking provided no risk reduction for hypertension compared to never vaping or smoking.