{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:46:19Z","timestamp":1791780379154,"version":"4.3.4"},"reference-count":36,"publisher":"Korean Society for Preventive Medicine","issue":"5","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003670","name":"National Evidence-based Healthcare Collaborating Agency","doi-asserted-by":"publisher","award":["NECA-S-25-006"],"award-info":[{"award-number":["NECA-S-25-006"]}],"id":[{"id":"10.13039\/501100003670","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Korea Disease Control and Prevention Agency","id":[{"id":"https:\/\/ror.org\/04jgeq066","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["jpmph.org"],"crossmark-restriction":true},"short-container-title":["JPMPH"],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:p>Objectives: Dual use of electronic and combustible cigarettes is increasing, but its association with cardiovascular outcomes, including stroke, remains unclear. This systematic review and meta-analysis evaluated associations of dual use with stroke and other cardiovascular outcomes compared with study-specific reference groups.Methods: Ovid-MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, KoreaMed, and the International Clinical Trials Registry Platform were searched for studies published from 2003 through September 2025. Comparative studies of adults reporting adjusted effect estimates for cardiovascular or cerebrovascular outcomes were eligible. When \u22655 methodologically comparable studies were available, random-effects meta-analysis with restricted maximum likelihood estimation was performed. Heterogeneity was assessed using the Cochran\u2019s Q test and Higgins I\u00b2 statistic. Leave-one-out analyses assessed the robustness of the pooled estimates.Results: Ten observational studies were included: 4 prospective cohort studies and 6 cross-sectional studies. Seven studies reported stroke outcomes. In pooled analyses of cross-sectional studies, dual use was associated with higher odds of stroke than never smoking (adjusted odds ratio, 1.90; 95% confidence interval [CI], 1.50 to 2.40), with substantial heterogeneity (I\u00b2=91.3%). Leave-one-out analyses yielded consistent results. Composite cardiovascular outcomes suggested elevated risk but were not pooled because outcome definitions varied substantially. One prospective cohort study reported increased all-cause mortality risk (adjusted hazard ratio, 2.44; 95% CI, 1.90 to 3.13).Conclusions: Dual use of electronic and combustible cigarettes was associated with higher odds of stroke than never smoking; however, evidence was predominantly cross-sectional and heterogeneous. Prospective studies using standardized exposure definitions and validated cardiovascular outcomes may clarify long-term cardiovascular risk.<\/jats:p>","DOI":"10.3961\/jpmph.26.243","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:48:08Z","timestamp":1787921288000},"page":"448-457","update-policy":"https:\/\/doi.org\/10.3961\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dual Use of Electronic and Combustible Cigarettes and Stroke Risk: A Systematic Review and Meta-analysis"],"prefix":"10.3961","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0331-5529","authenticated-orcid":true,"given":"Ah-Ram","family":"Sul","sequence":"first","affiliation":[{"name":"Division of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2850-5256","authenticated-orcid":true,"given":"Tae-Hyeok","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Korea University Sejong Campus, Sejong, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-0570","authenticated-orcid":true,"given":"Heejin","family":"Kimm","sequence":"additional","affiliation":[{"name":"Institute for Health Promotion, Graduate School of Transdisciplinary Health Sciences, Yonsei University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9573-8849","authenticated-orcid":true,"given":"Yu-Jin","family":"Paek","sequence":"additional","affiliation":[{"name":"Smoking Cessation Clinic, Department of Family Medicine and Health Promotion Center, Hallym University Sacred Heart Hospital, Anyang, 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