• E-cigarette use was associated with elevated risk for incident heart failure compared with never use.
• The association was significant even after adjustment for concomitant substance use and other risk factors.

ATLANTA — Individuals with a history of e-cigarette use may have increased risk for incident heart failure, regardless of concomitant cigarette, cigar, hookah or smokeless cigarette use, a speaker reported.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” Yakubu Bene-Alhasan, MD, resident physician at MedStar Health in Baltimore, said in a press release. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

Bene-Alhasan and colleagues used electronic health record data from the NIH-sponsored All of Us Research Program and responses to the Population Assessment of Tobacco and Health-styled questions to conduct a prospective analysis to better understand the association between e-cigarette use and incident HF. The overall cohort included 175,667 participants.

During a median follow-up of 45 months, 3,242 HF events occurred.

The findings were presented at the American College of Cardiology Scientific Session.

After adjusting for demographic factors, socioeconomic factors, diabetes, hypertension, hyperlipidemia, BMI and concomitant substance use — including cigarette, cigar, hookah, smokeless cigarette and alcohol use — users of e-cigarettes had an 19% greater risk for incident HF compared with never users (adjusted HR = 1.19; 95% CI, 1.06-1.35).

The researchers noted an increased risk for HF with preserved ejection fraction (aHR = 1.21; 95% CI, 1.01-1.47) and not HF with reduced EF (aHR = 1.11; 95% CI, 0.9-1.37).

The association between e-cigarette use and risk for incident HF was attenuated slightly after researchers excluded participants who reported having a history of cigarette, cigar, hookah and smokeless cigarette use (aHR = 1.04; 95% CI, 0.57-1.89).

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said in the release. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”