E-cigarettes are not a safer alternative to tobacco as far as strokes are concerned, according to a new study.

Young adults who use tobacco and e-cigarettes are nearly twice as likely to have a stroke as those who smoke only traditional cigarettes and almost three times as likely as nonsmokers, researchers say.

Risk doesn’t change

“While we already know that combustible cigarette use is one of the most important risk factors for stroke, [dual use] of e-cigarettes could potentially have an additive effect that may lead to stroke at a younger age,” said lead author Dr Tarang Parekh, a researcher at George Mason University in Fairfax, Virginia.

“In terms of a healthy alternative, if smokers were to switch to an e-cigarette, stroke risk does not change,” he added.

The study is one of the first aimed at gauging the potential stroke risk associated with use of e-cigarettes, said Dr Larry Goldstein, chairman of neurology at the University of Kentucky in Lexington. He reviewed the findings.

Because e-cigarettes are relatively new, Goldstein said it’s not surprising that the effect of their sole use on stroke risk is not yet apparent.

“But in no way should this be considered reassuring, as the impact on stroke risk may require longer periods of exposure and because of the study design, there are likely other unmeasured factors that could not be addressed that could affect risk,” Goldstein added.

Most concerning, he said, is that nearly 70% of sole e-cigarette users studied were 18 to 24 years old.

Risk among regular smokers

“This underscores the importance of restricting access to that population and removing incentives that could attract new users in this age group, such as flavoured products,” Goldstein said.

Also concerning is the increased risk among those who both vape and smoke regular cigarettes, as well as the risk among traditional smokers who switch to e-cigarettes, Goldstein said.

“Studies assessing the stroke, cardiovascular and other health risks of e-cigarettes and vaping are just beginning, and the long-term effects of exposure are largely unknown,” he said. “The relative lack of data should not be viewed as evidence of safety.”

For the study, Parekh and his team collected data on nearly 162,000 people between 18 and 44 who took part in a nationwide government health survey in 2016 and 2017.

Besides smoking, researchers took into account factors such as how often people used e-cigarettes and tobacco cigarettes and if they had high blood pressure, diabetes or high cholesterol. They also considered weight, physical activity and alcohol use.

They found that people who used e-cigarettes, tobacco cigarettes or both were more likely to be college dropouts or have only a high-school diploma. They were also more likely to be single, obese and binge drinkers.

Best strategy is quitting altogether

Stanton Glantz, director of the Center for Tobacco Control, Research and Education at the University of California, San Francisco, said most people don’t give up tobacco cigarettes for vaping. They’re likely to use both, which boosts their risk for both strokes and heart attacks.

Some proponents of vaping suggest that if people had used e-cigarettes all along instead of tobacco, there would have been fewer strokes and heart attacks, he said.

“But that’s not what the world is,” Glantz said. “The world is smoking tobacco and adding e-cigarettes. Long-term, they’re worse off than if they switch and no better off than if they use both.”

The best strategy for your health is to not smoke or vape, Glantz said.

The report was published in the American Journal of Preventive Medicine.

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