New Research: Youth Vaping and Stroke Risk

It’s that time again: time for researchers to announce misleading, overly alarming results from a study on vaping. While these kinds of news releases may seem useful to a “scared straight” agenda for children, they are harmful for the rest of us, so we here at VV try to address them with facts, one by one.

[PS, hey researchers: teens don’t read your studies, or news releases, for the most part. This approach only froths up their parents even more, and so far that’s not working for anyone. That said, here we go.]

Elevated risk for stroke? Maybe, for some.

This latest finding claims that young adults who both smoke cigarettes and use e-cigarettes are almost twice as likely to have a stroke compared to those who only smoke cigarettes. They are almost three times more likely to have a stroke than non-smokers.

However, these claims are not as clear as they seem.

The researchers calculated adjusted odds ratios (AORs) for cerebrovascular events, or strokes. They did this by weighing a series of factors in the ratio, including body mass index; demographic factors; frequency of use; hypertension, diabetes, and cholesterol levels; physical activity; and alcohol use.

The differences in vaping and stroke risk they found were notable. Among current cigarette smokers the ratio was 1.59 compared to non-smokers. For former cigarette smokers who now vape e-cigarettes that number was 2.54. And for people who both vape and smoke, it was 2.91.

Importantly, though, the team found that there was no increased stroke risk from e-cigarette use by never smokers. In other words, simply starting to vape e-cigarettes carries with it no increased risk of stroke, according to their own metrics.

Therefore, it must be some other combination of factors causing the observed differences. The team explains this by saying that people who vape e-cigarettes alone tend to also enjoy younger age, higher insurance enrollment, better socioeconomic status, and normal cardiovascular health. In other words: there are lots of factors, not just vaping, that seem to be influencing their findings.

Future directions on vaping and stroke risk

The researchers do conclude that analyzing long-term effects of vaping e-cigarettes on cerebrovascular metabolism will be critical before completely dismissing higher risk of stroke—which seems reasonable. However, their claim that there is no “clear benefit from using e-cigarettes” to switch from smoking combustible cigarettes seems, at a minimum, questionable in light of other research.

In terms of the data researchers used in the study, the team drew on data from the 2016-2017 Behavior Risk Factor Surveillance System (BRFSS). This is an annual, nationwide, cross-sectional health survey that the Centers for Disease Control and Prevention (CDC) and all US states and territories conduct jointly. It is, in other words, like a national census to investigate smoking and vaping patterns among young adults.

To focus on vaping and stroke risk, the team analyzed survey data from 161,529 participants who were 18 to 44 years old. Just over half of the respondents were white (50.6 percent), female (53.1 percent), and single (50.3 percent). Almost half had annual incomes over $50,000. Just less than 25 percent identified as Hispanic.

Compared to non-smokers, vapers in the study—both those who also smoke and those who only vape—reported higher rates of “problematic” behaviors. These included binge drinking, college dropout / terminal high-school status, obesity, and unmarried status.

E-cigarettes may be a safer option for some to achieve smoking cessation, but this is a complex issue. Toxicity and nicotine dependence are a serious problem for any users, especially low-risk youth who are not struggling with addiction.

Many factors may influence how safe vaping is, such as how much nicotine is in vaping products. Actually parsing out some of these factors in future research endeavors may both shed light on these complex issues and help more experienced smokers trying to quit accept research about relative risks.

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