Although stroke was more prevalent in traditional smokers, e-cigarette smokers had early-onset stroke and higher odds for stroke at a younger age, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

For the study, researchers conducted a cross-sectional survey of the United States population, using the National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018, to find adult participants with a history of stroke. Researchers identified study participants’ smoking habits (e-cigarette, traditional, and dual smoking) and used the chi-square test, unpaired t-test, and multivariable logistic regression models to assess the association of e-cigarette use in the stroke population.

Among the NHANES respondents who identified as smokers, 9.72% were e-cigarette smokers, 60.91% were traditional smokers, and 29.37% were dual smokers. The overall stroke prevalence was 5.41% among all smokers. Among women with stroke, e-cigarette smoking was higher compared with traditional smoking (36.36% vs 33.91%; P <.001). E-cigarette use compared with traditional smoking was also more prevalent among Mexican Americans (21.21% vs 6.02%) and other Hispanics (24.24% vs 7.70%; P <.001). Stroke was more prevalent among traditional smokers than among e-cigarette or dual smokers (6.75% vs 1.09% vs 3.72%; P <.001).

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However, e-cigarette smokers experienced an earlier stroke onset compared with dual and traditional smokers (median age: 48 vs 50 vs 59 years, respectively; P <.001). Investigators used multivariable logistic regression analysis to show that e-cigarette smokers had higher odds of having a history of stroke compared with traditional smokers (adjusted odds ratio 1.15; 95% CI, 1.15-1.16; P <.001)

In response to this study, Dr Karen L. Furie, an AHA volunteer expert and chair of the Department of Neurology at Brown University’s Warren Alpert Medical School in Providence, Rhode Island, stated that nicotine and other chemicals in vaping products “can directly affect the lining of the blood vessels.”

“These can cause damage to the blood vessels that results in atherosclerosis, but it can also cause injury that weakens the strength of the blood vessels, predisposes to clot formation and can damage the blood vessels over time, so that individuals are at risk for both the ischemic and hemorrhagic stroke,” Dr Furie said in an AHA news release. “It’s quite possible that exposure at a younger age may cause irreversible damage to blood vessels throughout the body and particularly in the brain.”

She also noted that “it’s important that young people understand that e-cigarettes are not a safe alternative, and that the best way to preserve brain health and prevent stroke is to avoid all cigarettes and nicotine products.”

Additional prospective studies are needed to determine the long-term impact of e-cigarettes to mitigate the risk for cerebro- and cardiovascular disorders, according to the researchers.


Patel N, Patel U, Khurana M, et al. Relationship between e-cigarette smoking and stroke ­– a NHANES study. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Presentation 209.

E-cigarette users face 15% higher risk of stroke at a younger age than traditional smokers. News release. American Heart Association. November 8, 2021. Accessed November 10, 2021.

This article originally appeared on The Cardiology Advisor