Electronic cigarette use and chest pain in US adults: evidence from the PATH study

• Main Authors: Behrooz, Leili, Xie, Wubin, Goghari, Aboli, Robertson, Rosemarie, Bhatnagar, Aruni, Stokes, Andrew, Hamburg, Naomi M.
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2024
• Subjects: Medicine, Health and Life Sciences; Chest pain; Electronic cigarettes
• Online Access: https://hdl.handle.net/10356/178605
• Institution: Nanyang Technological University

Introduction: Electronic cigarettes (e-cigarette) were introduced for smoking cessation/reduction but have also become popular among the youth. Although e-cigarettes contain fewer toxins than combustible cigarettes, their long-term cardiovascular and pulmonary effects remain unknown. We aimed to assess the association between self-reported chest pain and e-cigarette use. Methods: We analyzed data from the PATH (Population Assessment of Tobacco and Health) study wave 4 (2016–2018) and wave 5 (2018–2019). Based on questionnaires from wave 4, we categorized tobacco use as: 1) non-use, 2) exclusive e-cigarette use, 3) combustible cigarette use, and 4) dual use. Presence of established cardiovascular disease was examined at wave 4, and participants aged >40 years were asked about chest pain during wave 5. We used binary logistic regression models to determine the association between tobacco exposures and self-reported chest pain. Results: We evaluated a total of 11254 adults. The rates of chest pain were 1518 out of 7055 non-users, 49 from 208 exclusive e-cigarette users, 1192 from 3722 combustible cigarette users, and 99 out of 269 dual users. In the multivariable models adjusted for relevant covariates, combustible cigarette users (adjusted odds ratio, AOR=1.77; 95% CI: 1.56–2.01) and dual users (AOR=2.22; 95% CI: 1.61–3.05) had higher odds of reporting ever having chest pain, as well as having chest pain in the past 30 days. Conversely, exclusive e-cigarette users had similar odds of reporting chest pain compared to non-users (AOR=1.03; 95% CI: 0.69– 1.54) and lower odds than combustible and dual users. In sensitivity analyses, categorizing individuals based on their reported history of cardiovascular disease, overall findings were similar. Conclusions: Exclusive e-cigarette use is associated with a lower rate of chest pain compared to combustible cigarette use and dual use.