Abstract Body: Background: Electronic cigarette (e-cigarette) has now become the second most popular tobacco product in the United States (U.S.). However, due to the relatively recent market entry of e-cigarettes, longitudinal evidence regarding their associations with cardiometabolic outcomes, which take time to develop, remains limited.
Objectives: To supplement scientific evidence on cardiometabolic effects of e-cigarette use (vaping), using longitudinal data from Wave 1 to 5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study.
Methods: This study included 13,098 participants aged 18 and older who had no history of hypertension at baseline enrollment in Wave 1 and completed follow-up questionnaires from Wave 2 to 5. Hypertension outcome was self-reported (N=1,831). E-cigarette use was categorized as “non-use” (N=8,001), “former use” (N=4,409), and “current use” (N=688), with current vapers defined as those reported both a history of vaping and recent vaping in order to examine the health effects of continued e-cigarette use. Weighted Cox models were used to assess the association between e-cigarette use and hypertension incidence, stratified by age groups. The model was adjusted for combustible cigarette use, sex, race, education, poverty, and alcohol consumption.
Results: Compared with non-vapers, current vapers had a significantly increased risk of incident hypertension (HR=1.27, 95% CI: 1.04, 1.56). However, no such association was observed among former vapers (HR=1.01, 95% CI: 0.89, 1.15). Both former (HR=1.29, 95% CI: 1.05, 1.58) and current (HR=1.33 95% CI: 1.07, 1.66) smokers were associated with elevated risk of incident hypertension compared with non-smokers.
Conclusions: To our knowledge, this study is the first to present the association between e-cigarette use and incident hypertension in a nationally representative cohort. One major strength of this study is that it demonstrates the significant effect of e-cigarette use that is independent of the traditional risk factor and strong confounder, combustible cigarette use. The findings highlight the negative impacts of e-cigarettes use on hypertension and underscore the importance of public health interventions targeting this modifiable risk factor to reduce the cardiovascular health burden in U.S. adults. Further study with longer follow up periods are needed to capture more incidences in order to increase statistical power for stratifying analyses across age groups and sexes.