A NEW longitudinal study from the All of Us Research Program sheds light on the potential cardiometabolic consequences of exclusive e-cigarette use and dual tobacco use in adults across the United States. In this large-scale analysis of over 249,000 participants followed for an average of 3.7 to 3.9 years, researchers found that exclusive e-cigarette use was significantly associated with the development of chronic obstructive pulmonary disease (COPD) and, in adults aged 30 to 70 years, with hypertension.
The study compared current exclusive e-cigarette users, exclusive combustible cigarette users, and dual users with non-users. While exclusive e-cigarette use was not significantly associated with type 2 diabetes, heart failure, or atherosclerotic cardiovascular disease (ASCVD) overall, it was strongly associated with incident COPD (HR 2.29, 95% CI 1.42–3.71). Among adults aged 30–70 years, exclusive e-cigarette use was also significantly linked to increased risk of hypertension (HR 1.39, 95% CI 1.09–1.77).
In contrast, both exclusive combustible cigarette use and dual use were consistently and strongly associated with all cardiometabolic outcomes. Dual users exhibited the highest point estimates across most conditions. Notably, dual use was associated with a markedly elevated risk of ASCVD (HR 2.18, 95% CI 1.82–2.62), suggesting an additive or synergistic health burden.
These findings support the need for ongoing surveillance of novel tobacco product use and its long-term health impact. For clinicians, the data emphasize the importance of not only asking patients about smoking status but also about e-cigarette and dual product use, particularly when assessing cardiometabolic risk.
Reference:
Erhabor J et al. E-cigarette use and incident cardiometabolic conditions in the All of Us Research Program. Nicotine Tob Res. 2025;ntaf067.
