{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:20:01Z","timestamp":1782933601760,"version":"3.54.5"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Drug Abuse, National Institutes of Health, and the Center for Tobacco Products, Food and Drug Administration (FDA), Department of Health and Human Services","award":["HHSN271201100027C ; HHSN271201600001C"],"award-info":[{"award-number":["HHSN271201100027C ; HHSN271201600001C"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Prior studies have not clearly established risk of cardiovascular disease (CVD) among smokers who switch to exclusive use of electronic nicotine delivery systems (ENDS). We compared cardiovascular disease incidence in combustible-tobacco users, those who transitioned to ENDS use, and those who quit tobacco with never tobacco users. Methods: This prospective cohort study analyzes five waves of Population Assessment of Tobacco and Health (PATH) Study data, Wave 1 (2013\u20132014) through Wave 5 (2018\u20132019). Cardiovascular disease (CVD) incidence was captured over three intervals (Waves 1 to 3, Waves 2 to 4, and Waves 3 to 5). Participants were adults (40+ years old) without a history of CVD for the first two waves of any interval. Change in tobacco use status, from exclusive past 30 day use of any combustible-tobacco product to either exclusive past 30 day ENDS use, dual past 30 day use of ENDS and combustible-tobacco, or no past 30 day use of any tobacco, between the first two waves of an interval was used to predict onset of CVD between the second and third waves in the interval. CVD incidence was defined as a new self-report of being told by a health professional that they had congestive heart failure, stroke, or a myocardial infarction. Generalized estimating equation (GEE) analyses combined 10,548 observations across intervals from 7820 eligible respondents. Results: Overall, there were 191 observations of CVD among 10,548 total observations (1.7%, standard error (SE) = 0.2), with 40 among 3014 never users of tobacco (1.5%, SE = 0.3). In multivariable models, CVD incidence was not significantly different for any tobacco user groups compared to never users. There were 126 observations of CVD among 6263 continuing exclusive combustible-tobacco users (adjusted odds ratio [AOR] = 1.44; 95% confidence interval (CI) 0.87\u20132.39), 15 observations of CVD among 565 who transitioned to dual use (AOR = 1.85; 0.78\u20134.37), and 10 observations of CVD among 654 who quit using tobacco (AOR = 1.18; 0.33\u20134.26). There were no observations of CVD among 53 who transitioned to exclusive ENDS use. Conclusions: This study found no difference in CVD incidence by tobacco status over three 3 year intervals, even for tobacco quitters. It is possible that additional waves of PATH Study data, combined with information from other large longitudinal cohorts with careful tracking of ENDS use patterns may help to further clarify this relationship.<\/jats:p>","DOI":"10.3390\/ijerph19074137","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T21:33:03Z","timestamp":1648762383000},"page":"4137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cardiovascular Outcomes among Combustible-Tobacco and Electronic Nicotine Delivery System (ENDS) Users in Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) Study, 2013\u20132019"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5069-1140","authenticated-orcid":false,"given":"Martin C.","family":"Mahoney","sequence":"first","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0179-1495","authenticated-orcid":false,"given":"Cheryl","family":"Rivard","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8278-0095","authenticated-orcid":false,"given":"Heather L.","family":"Kimmel","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda T.","family":"Hammad","sequence":"additional","affiliation":[{"name":"Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Sharma","sequence":"additional","affiliation":[{"name":"Westat, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8703-3811","authenticated-orcid":false,"given":"Michael J.","family":"Halenar","sequence":"additional","affiliation":[{"name":"Westat, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Sargent","sequence":"additional","affiliation":[{"name":"The C. Everette Koop Institute at Dartmouth, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7103-7017","authenticated-orcid":false,"given":"K. Michael","family":"Cummings","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0856-3540","authenticated-orcid":false,"given":"Ray","family":"Niaura","sequence":"additional","affiliation":[{"name":"NYU School of Global Public Health, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-3068","authenticated-orcid":false,"given":"Maciej L.","family":"Goniewicz","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maansi","family":"Bansal-Travers","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Hatsukami","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, MN 55414, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diann","family":"Gaalema","sequence":"additional","affiliation":[{"name":"University of Vermont, Burlington, VT 05404, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Fong","sequence":"additional","affiliation":[{"name":"University of Waterloo, Waterloo, ON N2L 3G1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5224-9105","authenticated-orcid":false,"given":"Shannon","family":"Gravely","sequence":"additional","affiliation":[{"name":"University of Waterloo, Waterloo, ON N2L 3G1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol H.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Haskins","sequence":"additional","affiliation":[{"name":"Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marushka L.","family":"Silveira","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA"},{"name":"Kelly Government Solutions, Troy, MI 48084, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Blanco","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3108-5118","authenticated-orcid":false,"given":"Wilson","family":"Compton","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra A.","family":"Stanton","sequence":"additional","affiliation":[{"name":"Westat, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hyland","sequence":"additional","affiliation":[{"name":"Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"ref_1","unstructured":"Public Health Service (1964). 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