Electronic cigarettes and cardiovascular diseases: An updated systematic review and network meta-analysis
2
Issued Date
2025-09-01
Resource Type
eISSN
16179625
Scopus ID
2-s2.0-105017408941
Journal Title
Tobacco Induced Diseases
Volume
23
Rights Holder(s)
SCOPUS
Bibliographic Citation
Tobacco Induced Diseases Vol.23 (2025)
Suggested Citation
Tansawet A., Anothaisintawee T., Boonmanunt S.W., Pornsuriyasak P., Sukhato K., Chawala N., Inpithuk P., Savigamin C., Liampeng S., Attia J., McKay G.J., Thakkinstian A. Electronic cigarettes and cardiovascular diseases: An updated systematic review and network meta-analysis. Tobacco Induced Diseases Vol.23 (2025). doi:10.18332/tid/208065 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112440
Title
Electronic cigarettes and cardiovascular diseases: An updated systematic review and network meta-analysis
Corresponding Author(s)
Other Contributor(s)
Abstract
INTRODUCTION The association between electronic cigarettes (e-cigarettes) and the risk of cardiovascular disease (CVD) remains inconclusive. This study aims to compare CVD risk from the use of e-cigarettes, cigarettes, combined cigarette and e-cigarette use, and non-use. METHODS This study is a systematic review and network meta-analysis (NMA). MEDLINE and Scopus databases (through February 2024) were used to identify eligible studies. Observational studies that investigated the effect of e-cigarettes on the risk of composite CVD, myocardial infarction (MI), or stroke, compared to cigarette, dual use, or non-use, were included. NMA was applied to estimate relative effects (i.e. adjusted odds ratio, AOR) of e-cigarette, cigarette, and dual use, on composite CVD, MI, and stroke outcomes. Risk of bias was assessed using the Joanna Briggs Institute tool for surveys and the Newcastle-Ottawa scale for cohort studies. RESULTS Eleven adult population studies were eligible for review. E-cigarette, cigarette, and dual use were significantly associated with composite CVD outcomes. Pooled AORs (95% CI) were 1.31 (1.05-1.62) for e-cigarette, 1.57 (1.30-1.88) for cigarette, and 1.67 (1.37-2.03) for dual use. Additionally, former cigarette and former dual use significantly increased the risk of composite CVD outcomes, compared to non-use. The pooled AORs (95% CI) were 1.29 (1.05- 1.59) for former cigarette, and 1.46 (1.03-2.08) for former dual use, while former e-cigarette use was not significantly associated with composite CVD endpoints. For MI and stroke outcomes, only cigarette and dual use were significantly associated with these events. CONCLUSIONS Current e-cigarette, cigarette, and dual use were significantly associated with increased risk of composite CVD outcomes, while only cigarette and dual use significantly increased the risk of MI and stroke, compared to non-use. However, these findings were primarily based on cross-sectional data limiting the temporality of effect; additional prospective cohort studies are needed to confirm our findings.