Are you vaping and smoking? That boosts the likelihood of a stroke, study says

Jorge Velez, a sales associate at XS Vapor Craft Beer Bar & Lounge in North Miami, switched from smoking traditional tobacco cigarettes to vaping.

At first he vaped using a non-disposable vape pen, or e-cigarette, which requires “vape juice.” But he then switched to disposable vapes, which come with nicotine salt inside.

“You get more of a nicotine high and quicker,” the 21-year-old said of the concentrated nicotine salt or “salt nic,” as it’s commonly called. “People like that, especially when they’re coming off of cigarettes. It’s very addictive.”

Nicotine salt enters the bloodstream faster than traditional vape juice and provides a blood absorption rate closer to an actual cigarette.

Filling the glass counters in front of him are a treasure trove of brightly packaged salt nics as well as vape juices. Vape juice, or e-juice ingredients, contain flavoring, nicotine, vegetable glycerin (VG) and propylene glycol (PG), which is a synthetic liquid substance that absorbs water.

“What also makes these really addictive are the flavors,” he says as he pulls out mango-, pineapple- and orange-flavored vape juices. “That’s why people like it. The combination of flavor and nicotine gives them the feeling they want.”

He says he has cut down on vaping. “I started having problems in my lungs, like sharp pains and coughing when I used the disposable vapes with the nicotine salt.”

Last summer, an outbreak of lung injuries associated with e-cigarette use was reported in the U.S. Some experts think that vitamin E acetate, which is an ingredient found in some vape pens containing THC, may be the culprit.

Now, there are concerns that the combination of vaping e-cigarettes and smoking traditional cigarettes may increase the risk of stroke.

Stroke risk

A 2016 study, conducted by a team at George Mason University in Fairfax, Virginia, found that young adults who smoked traditional cigarettes and vaped e-cigarettes were nearly twice as likely to suffer a stroke compared with traditional cigarette smokers.

Those who both vaped and smoked had an increased risk of stroke when compared with non-smokers. The results, which relied on self-reported data, also revealed there was no clear advantage to switching from traditional cigarettes to e-cigarettes.

People who vaped who had never smoked before did not exhibit an increased stroke risk, according to the study. The experts suspected this could be due to young age and normal heart health.

“E-cigarette use in young adults has become a popular trend,” said Steven Resnick, D.O., who is the chief of the department of neurology and the stroke medical director at Mount Sinai Medical Center in Miami Beach.

“Many adults are using the variety of e-cigarette flavors to substitute conventional cigarette smoking,” he said. “E-cigarettes also contain several ingredients including nicotine, leading to addiction with potential subsequent harmful cerebrovascular effects. Educating our young adult population about the risks of cigarette smoking and e-cigarette use is important for primary stroke prevention.”

Last year, Mount Sinai treated nearly 900 stroke patients. The medical center is among a few facilities in Florida to be designated as a Comprehensive Stroke Center by the Florida Agency for Health Care Administration.

Resnick said that Mount Sinai participates in several educational awareness programs for the community, and as a primary stroke center, provides up-to-date therapeutic medication treatment options and endovascular therapies.

Deaths caused by e-cigarettes, vape pens

In December, the Centers for Disease Control and Prevention reported that more than 2,500 people from the U.S., Puerto Rico, and the U.S. Virgin Islands were hospitalized or died due to using e-cigarettes or vape pens.

“One of the more important health risks with the use of e-cigarettes in adolescents and young adults continues to be the effects of nicotine,” said Dr. Metee Comkornruecha, director of adolescent medicine at Nicklaus Children’s Hospital near South Miami.

“Because the adolescent and young adult brain is under continued development, the introduction of nicotine can affect impulse control, attention and learning,” he said. “Nicotine is an extremely addictive chemical.’’

“Another potential adverse health risk with the use of e-cigarettes is lung injury,” he said. “Chemicals in the e-liquid have the potential to cause severe lung injury that has led to death. Vitamin E acetate is a chemical that has been potentially associated with these recent cases.”

A nationwide survey, taken in 2016, found that 10.8 million adults in the United States vape.

The analysis, published in the Annals of Internal Medicine, found that 54.6 percent of e-cigarette users were also smoking cigarettes. About 15 percent of vapers had never smoked cigarettes, and 30.4 percent had quit smoking them.

The study is based on data from the Behavioral Risk Factor Surveillance System, a national survey conducted by the CDC.

More than half of e-cigarette users were younger than 35, and the prevalence decreased with increasing age. Usage was highest among people ages 18 to 24, who were both occasional and daily users.

The researchers surveyed 486,000 people who were 18 and older by telephone in every state, as well as Guam, Puerto Rico and the Virgin Islands in 2016.

And according to preliminary data from the University of Michigan’s Monitoring the Future (MTF) survey, the shares of secondary students (8th through 12th grade) who have vaped nicotine in the past month nearly doubled since 2017. From 2017 to 2019, the percentage of students who had done so increased among 12th-graders (11% to 25%), 10th-graders (8% to 20%) and 8th-graders (4% to 9%).

“While they did not show an increased stroke risk with persons who used e-cigarettes only,” said Comkornruecha of the study, “our concern remains the addictive potential to nicotine leading to initiation of conventional cigarettes in these youth.”