{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:45:33Z","timestamp":1791819933973,"version":"4.3.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54-CA229974"],"award-info":[{"award-number":["U54-CA229974"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The cardiovascular health effects of electronic nicotine delivery systems (ENDS) use are not well characterized, making it difficult to assess ENDS as a potential harm reduction tool for adults who use cigarettes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>Using waves 1\u20135 of the Population Assessment of Tobacco and Health Study (2013\u20132019), we analyzed the risk of self-reported incident diagnosed myocardial infarction (MI; 280 incident cases) and stroke (186 incident cases) associated with ENDS and\/or cigarette use among adults aged 40\u2005+\u2005using discrete time survival models. We employed a time-varying exposure lagged by one wave, defined as exclusive or dual established use of ENDS and\/or cigarettes every day or some days, and controlled for demographics, clinical factors, and past smoking history.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The analytic samples (MI\u2005=\u200511 031; stroke\u2005=\u200511 076) were predominantly female and non-Hispanic White with a mean age of 58 years. At baseline, 14.2% of respondents exclusively smoked cigarettes, 0.6% exclusively used ENDS, and 1.0% used both products. Incident MI and stroke were rare during follow-up (&amp;lt; 1% at each wave). Compared to no cigarette or ENDS use, exclusive cigarette use increased the risk of MI (aHR 1.99, 95% CI = 1.40\u20132.84) and stroke (aHR 2.26, 95% CI = 1.51\u20133.39), while exclusive ENDS use (MI: aHR 0.61, 95% CI = 0.12\u20133.04; stroke: aHR 1.74, 95% CI = 0.55\u20135.49) and dual use (MI: aHR 1.84, 95% CI = 0.64\u20135.30; stroke: aHR 1.12, 95% CI = 0.33\u20133.79) were not significantly associated with the risk of either outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Compared to non-use, exclusive cigarette use was associated with an increased risk of self-reported incident diagnosed cardiovascular disease over a 5-year period, while ENDS use was not associated with a statistically significant increase in the outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>Existing literature on the health effects of ENDS use has important limitations, including potential reverse causation and improper control for cigarette smoking. We accounted for these issues by using a prospective design and adjusting for current and former smoking status and cigarette pack-years. In this context, we did not find that ENDS use was associated with a statistically significant increase in self-reported incident diagnosed myocardial infarction or stroke over a 5-year period. While more studies are needed, this analysis provides an important foundation and key methodological considerations for future research on the health effects of ENDS use.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntac182","type":"journal-article","created":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T21:59:10Z","timestamp":1659218350000},"page":"386-394","source":"Crossref","is-referenced-by-count":20,"title":["Longitudinal Associations Between Exclusive and Dual Use of Electronic Nicotine Delivery Systems and Cigarettes and Self-Reported Incident Diagnosed Cardiovascular Disease Among Adults"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6532-1372","authenticated-orcid":false,"given":"Jana L","family":"Hirschtick","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, MI , 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7707-5092","authenticated-orcid":false,"given":"Douglas","family":"Arenberg","sequence":"additional","affiliation":[{"name":"Pulmonary Clinic, Department of Internal Medicine, University of Michigan Health System , Northville, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5365-5399","authenticated-orcid":false,"given":"Irina","family":"Bondarenko","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health , Ann Arbor, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5280-3612","authenticated-orcid":false,"given":"David T","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center , Washington, D.C. , 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