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. 2025 Jan:190:108181.
doi: 10.1016/j.ypmed.2024.108181. Epub 2024 Nov 17.

Sex-specific associations of cigarettes and e-cigarettes use with self-reported premature atherosclerotic cardiovascular disease among adults aged 18-54 in the United States

Ememgini Elo-Eghosa  1 , Wei Li  2 , Mohammad Ebrahimi Kalan  3 , Nan Hu  4 , Olatokunbo Osibogun  5
Affiliations

Sex-specific associations of cigarettes and e-cigarettes use with self-reported premature atherosclerotic cardiovascular disease among adults aged 18-54 in the United States

Ememgini Elo-Eghosa et al. Prev Med. 2025 Jan.

Abstract

Background: Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences.

Methods: Using pooled data from 480,317 adults (ages 18-54; ∼50 % female) from the 2020-2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex.

Results: After controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47-1.94]) and current dual (2.03 [1.69-2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females.

Conclusion: Both sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD.

Keywords: BRFSS; Cardiovascular disease; Cigarettes; Dual use; E-cigarettes; Premature ASCVD.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Aggarwal R, Yeh RW, Joynt Maddox KE, & Wadhera RK (2023). Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020. JAMA : The Journal of the American Medical Association, 329(11), 899–909. 10.1001/jama.2023.2307 - DOI - PMC - PubMed
    1. Alam F, & Silveyra P (2023). Sex Differences in E-Cigarette Use and Related Health Effects. International Journal of Environmental Research and Public Health, 20(22), 7079. 10.3390/ijerph20227079 - DOI - PMC - PubMed
    1. Andersson C, & Vasan RS (2018). Epidemiology of cardiovascular disease in young individuals. Nature Reviews Cardiology, 15(4), 230–240. 10.1038/nrcardio.2017.154 - DOI - PubMed
    1. Appelman Y, van Rijn BB, Ten Haaf ME, Boersma E, & Peters SA (2015). Sex differences in cardiovascular risk factors and disease prevention. Atherosclerosis, 241(1), 211–218. 10.1016/j.atherosclerosis.2015.01.027 - DOI - PubMed
    1. Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, & Moran AE (2015). Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. Archives of Medical Research, 46(5), 328–338. 10.1016/j.arcmed.2015.06.006 - DOI - PubMed