Re-examining the Association Between E-Cigarette Use and Myocardial Infarction: A Cautionary Tale

Introduction: Cross-sectional analyses have suggested that e-cigarette use, independent of com-bustible cigarette use, elevates the risk of myocardial infarction. Previous researchers confused their own models' assumptions that these risks were independent with the idea that their analyses vali-dated the presence of independent risks. This study avoids this pitfall. Methods: Cross-sectional analyses of the 2014-2019 National Health Interview Surveys (N=175,546) were conducted in 2020. Results: Logistic regressions found that e-cigarette use was associated with having had a myocar-dial infarction, but this association significantly varied on the basis of one's smoking history. With a host of demographic and clinical variables controlled, e-cigarette use was associated with lifetime myocardial infarction occurrence only among current smokers. A counterfactual analysis first removed all (current or former) e-cigarette-using respondents who had suffered a myocardial infarction without a history of smoking. The independent-effects model used in previous research misleadingly indicated that daily vaping increases never smokers' odds of having had a myocardial infarction by 1.55 (95% CI=1.11, 2.15), even though no such myocardial infarction sufferers remained in the analyzed data. The association between myocardial infarction and vaping daily has shown a significant annual decline (AOR=0.81, 95% CI=0.67, 0.98). Conclusions: There is no reliable evidence that e-cigarette use is associated with ever having had a myocardial infarction among never smokers. Contrary to concerns that the harms associated with e-cigarettes are only now emerging after more years of possible product use, the only evidence of time-dependent variation in the association between e-cigarette use and myocardial infarction ran counter to this possibility. The scientific community must insist that researchers engage in accurate public communication of peer-reviewed findings. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc.

Automated summary

The study found an association between e-cigarette use and myocardial infarction risk, which varied based on smoking history. No association was found between e-cigarette use and myocardial infarction among never smokers. The research emphasizes the importance of accurate public communication of scientific findings.