US Pharm. 2019;44(5):5.

According to new research, worries over additives in e-cigarettes are buttressing the general concern about the products’ safety. Research presented in early March at the American College of Cardiology’s (ACC) 68th Annual Scientific Session finds that adults who practice puffing e-cigarettes, or vaping, are much more likely to have a heart attack, coronary artery disease, and depression compared with those who do not use them or other tobacco products.

The research study—which included data from a total of 96,467 respondents from the National Health Interview Survey and a CDC survey of Americans from 2014, 2016, and 2017—found that (before adjusting for various cardiovascular risk factors), compared with nonusers, e-cigarette users were 56% more likely to have a heart attack and 30% more likely to suffer a stroke.

“Until now, little has been known about cardiovascular events relative to e-cigarette use. These data are a real wake-up call and should prompt more action and awareness about the dangers of e-cigarettes,” said Mohinder Vindhyal, MD, assistant professor at the University of Kansas School of Medicine–Wichita and lead author.

Citing health concerns, some are also sounding the alarm about the growth of vaping among teens and young adults. As reported in this issue’s CE article (which was in production before the ACC Scientific Session presentation’s release), “The Burgeoning Health Crisis of Youth and e-Cigarettes,” by Elsen C. Jacob, PharmD, BCPS, BCGP, CPPS, the CDC indicated that in 2018, 3.05 million, or 20.8%, of high school students disclosed e-cigarette use—a large increase compared with 1.5%, or 220,000 students, 7 years before. Even more alarming, Dr. Jacob writes, was a 78% increase in e-cigarette use among high school students and a 48% increase in use among middle school students in just 1 year (2017–2018).

Indoctrination to e-cigarettes and vaping, Dr. Jacob points out, often happens at a particularly vulnerable time—adolescence, a transitional stage from childhood to adulthood when significant maturation of cognition and emotion occurs. This developmental period also increases an individual’s proclivity for risk-taking and other behavioral changes that lead to adult autonomy. “Thus unsurprisingly,” he writes, “approximately 90% of adult tobacco users are reported to have developed their habit during adolescence.”

Dr. Jacob is especially critical of e-cigarette companies’ marketing practices, which are often geared to younger customers. “They have utilized the historical strategies of cigarette companies, which included flavored products that are appealing to young people, sexual content, and endorsements by celebrities.”

What can the pharmacy community do to guard against this health threat to young adults? It is vital he urges, that pharmacists “are equipped to counsel patients, especially youth, on the dangers of e-cigarette products.”

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