In June 2019, a study using data from the US PATH study claimed that people who use e-cigarettes are more likely to have had a heart attack. The summary of the paper by Bhatta and Glanz (1) said (quoted here with grammatical errors included in the publication) “Effect of e-cigarettes are similar as conventional cigarette and dual use of e-cigarettes and conventional cigarettes at the same time is risker than using either product alone”.

The paper generated widespread claims about dangers of vaping, but in February 2020, it was withdrawn from the journal (2) for the following reasons.

People who smoke have a higher risk of having a heart attack. Almost all adult vapers are former smokers, and it takes almost 20 years after quitting smoking for the risk to fall close to that in non-smokers. Among those who have switched from smoking to vaping recently, the risk will be very similar to those who are still smoking. This means that a link between vaping and heart attacks is entirely predictable.

However, to claim that it is the vaping that causes heart attacks (and not the previous smoking), e-cigarette use must take place before people had the heart attack. An independent analysis of the PATH data by Professor Brad Rodu of the University of Louisville showed that the authors of the paper did not make sure that this was the case. The journal editors therefore decided that the findings were unreliable, and that the paper should be withdrawn.

Professor Glantz has published two other papers based on analyses of the PATH data, one stating that e-cigarette use by young people was linked to becoming a regular smoker (3), and one suggesting a link between vaping and later chronic lung disease (4). Both have been strongly criticised: the first because it did not factor in that the young people were already smoking when they tried e-cigarettes (5), and the second because the lung diseases involved take many years to develop, and so could not have been caused by recent vaping (6). At the time of writing, however, neither of the papers have been withdrawn.

John Britton

(1) Bhatta, D.N. and Glantz, S.A. Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis. Am J Prev Med, 2019. 10.1016/j.amepre.2019.07.028.

(2) Retraction to: Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health. Journal of the American Heart Association, 2020; 9: e014519.

(3) Chaffee, B.W., Watkins, S.L., and Glantz, S.A. Electronic Cigarette Use and Progression From Experimentation to Established Smoking. Pediatrics, 2018. 10.1542/peds.2017-3594.

(4) Bhatta, D.N. and Glantz, S.A. Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis. Am J Prev Med, 2019. 10.1016/j.amepre.2019.07.028.

(5) Rodu B, Plurphanswat N. Electronic Cigarette Use and Progression From Experimentation to Established Smoking. https://pediatrics.aappublications.org/content/141/4/e20173594/tab-e-letters#re-electronic-cigarette-use-and-progression-from-experimentation-to-established-smoking

(6) Britton J. Vaping and lung disease. The Times, Tuesday December 17 2019 https://www.thetimes.co.uk/article/times-letters-proposed-overhaul-of-defence-spending-xmm9hwd8m

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