Cardiovascular Risk Among Stroke Survivors With Combustible and Electronic Cigarettes: A Nationwide Study in Korean Men

Abstract

Background Although use of electronic cigarettes (e-cigarettes) is increasing, its cardiovascular impact remains uncertain, especially among stroke survivors. We compared the incidence of major cardiovascular events in stroke survivors according to cigarette/e-cigarette use.Methods We conducted a retrospective cohort study of Korean men with acute stroke who underwent national health checkups within 3 years of the index stroke (2018-2022). The patients were categorized into 4 groups based on their cigarette/e-cigarette use status: nonusers, combustible cigarette users, dual users (both combustible cigarettes and e-cigarettes), and e-cigarette-only users. The primary outcome was a composite of recurrent stroke and myocardial infarction. Multivariable Cox models estimated hazard ratios (HRs) across groups.Results Of the 115 240 men with stroke, 89 326 (77.5%) were nonusers, 23 688 (20.6%) were combustible cigarette users, 1498 (1.3%) were dual users, and 728 (0.7%) were e-cigarette-only users. During a mean follow-up of 2.61 +/- 1.46 years, 6722 patients suffered primary outcome events (ischemic stroke: 4799; hemorrhagic stroke: 1165; myocardial infarction: 758). Compared with nonusers, the risk of the primary outcome was higher in the combustible cigarette group (HR, 1.35 [95% CI, 1.27-1.43]) and dual users (HR, 1.27 [95% CI, 1.01-1.60]), whereas e-cigarette-only users showed a nonsignificant elevation (HR, 1.11 [95% CI, 0.77-1.59]).Conclusions Among Korean male stroke survivors, combustible cigarette use and dual use were associated with higher risk of recurrent stroke or myocardial infarction, whereas e-cigarette-only use was not significantly different from nonuse. Further research is warranted to clarify the long-term cardiovascular effects of e-cigarette use among stroke survivors.