A recently published study reported that “electronic cigarette use is associated with myocardial infarction“. A group of researchers from US teamed up with prof. Riccardo Polosa, CoEHAR Founder, and raised concerns over study conclusions and design.
Recently, a paper published by prof. Alzahrani, “Electronic Cigarette Use and Myocardial Infarction”, concluded that “E-cigarettes are associated with myocardial infarction in subjects who have never smoked cigarettes. The findings of this study suggest that it is essential to raise awareness of the potential risks of e-cigarettes, especially among youth and young adult”.
The COEHAR founder, prof. Riccardo Polosa, in collaboration with experts from US (Floe Foxon, Ray S. Niaura, K. Michael Cummings, Michael Siegel and Neal Benowitz) published a commentary to analyze data and methodologies used to support the paper’s conclusions.
With regard to this study, researchers raised some concerns:
1) Temporality concerns: The myocardial infarctions (MIs) reported for the current-e-cigarette-using group may have occurred before respondents started using e-cigarettes
2) Measurement, diagnosis, and biological plausibility concerns: no examination of duration and frequency of use of e-cigarettes, both of which are factors that are important in assessing the health risks of using e-cigarettes, especially for an outcome such as cardiovascular disease.ù
3) Sample size concerns: The most glaring omissions in the paper are the raw number of adults in the e-cigarette-using group who experienced heart attacks, as well as the age distribution of these events, neither of which were reported.
4) Model design concerns: With so few events, it seriously limits the ability to perform a reliable analysis,
5) Uncareful language: different statement are made in the discussion section of the paper by Alzarhani (“[t]he cross-sectional design of this study means that it can only identify associations, not causal relationships”) and in the Abstract of the article, where a much more affirmative statement is made: “e-cigarette use increases the risks of cardiovascular disease”