Behavior
Sex-Specific Associations of Cigarettes, E-cigarettes and Dual Use with Premature Atherosclerotic Cardiovascular Disease Olatokunbo Osibogun* Olatokunbo Osibogun Ememgini Elo-Eghosa
Background: Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years), posing challenges to future health and productivity. While research suggests a higher risk in females who smoke cigarettes compared to males, sex differences in the impact of cigarette and e-cigarette use patterns on premature ASCVD are limited. This study investigated these sex-specific associations using data from a population-based sample.
Methods: Using data from 480,317 adults (ages 18-54; ~50% female) in the 2020-2022 Behavioral Risk Factor Surveillance System, logistic regression models were used to assess the associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD, stratified by sex.
Results: In females, former dual (adjusted odds ratio: 1.38 [95% CI: 1.05, 1.81]), current exclusive cigarette (1.54 [1.19, 2.00]), current cigarette/former e-cigarette (1.39 [1.11, 1.76]), and current dual (2.20 [1.50, 3.23]) use were positively associated with premature ASCVD compared to never use. Conversely, former exclusive e-cigarette, current exclusive e-cigarette, former exclusive cigarette, and former cigarette/current e-cigarette use showed no significant association.In males, former exclusive cigarette (1.40 [1.11, 1.76]), former dual (1.60 [1.24, 2.07]), current exclusive cigarette (1.81 [1.40, 2.33]), current cigarette/former e-cigarette (1.99 [1.52, 2.53]), and current dual (2.18 [1.56, 3.06]) use were positively associated with premature ASCVD. Former exclusive e-cigarette use showed a negative association, while current exclusive e-cigarette and former cigarette/current e-cigarette use showed no significant association.
Conclusion: Both sexes showed higher odds of premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design limits causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce premature ASCVD.