E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program.

Summary

In 249,190 adults followed ~3.8 years, exclusive e-cigarette use was longitudinally associated with incident COPD (HR 2.29) and, among ages 30–70, with hypertension (HR 1.39). Exclusive combustible and dual use were strongly associated with all cardiometabolic outcomes, with dual use potentially conferring higher ASCVD risk.

Key Findings

• Exclusive e-cigarette use associated with incident COPD (HR 2.29, 95% CI 1.42–3.71).
• Hypertension association observed for exclusive e-cigarette use in ages 30–70 (HR 1.39, 95% CI 1.09–1.77).
• Exclusive combustible and dual use strongly associated with all outcomes; dual use showed higher ASCVD risk estimate (HR 2.18) than combustible alone.

Clinical Implications

Counseling should include COPD risks from exclusive e-cigarette use and possible hypertension risk in adults aged 30–70, while reinforcing that dual and combustible use confer broad cardiometabolic harms.

Limitations

• Observational design limits causal inference and residual confounding is possible.
• Exposure misclassification (self-report, switching patterns) may bias estimates.

Future Directions

Triangulate with biomarker-verified exposure, device/liquid composition data, and extended follow-up to refine risk estimates; evaluate regulatory impacts on switching trajectories and health outcomes.