Anti-Vaping Researchers Claim E-Cigarettes Cause Heart Attacks Before Smokers Try Them

A study suggesting that e-cigarettes double the risk of a heart attack ignored crucial information on timing.


Last month the Journal of the American Heart Association published a study that claimed "e-cigarette use is an independent risk factor for having had a myocardial infarction." Based on data from the Population Assessment of Tobacco and Health (PATH), the researchers found that vapers were twice as likely to report heart attacks as subjects who had never smoked or vaped. In a blog post, study co-author Stanton Glantz, a longtime anti-smoking activist who directs the Center for Tobacco Research Control & Education at the University of California, San Francisco, described that finding as "more evidence that e-cigs cause heart attacks."

But according to Brad Rodu, a tobacco researcher at the University of Louisville, most of the e-cigarette users who reported heart attacks had them before they started vaping, which makes Glantz's causal inference logically impossible. In a July 11 letter to the journal's editors, Rodu noted that Glantz and his co-author, Dharma Bhatta, "failed to account for detailed information in that survey on (a) when participants were first told that they had a heart attack and (b) when participants first started using e-cigarettes."

When Rodu and University of Louisville research economist Nantaporn Plurphanswat looked at that information, they found that most of the 38 vapers who reported heart attacks "were first told that they had a heart attack many years before they first started using e-cigarettes." In that group, "heart attacks preceded first e-cigarette use by almost a decade on average." When Rodu and Plurphanswat ran the numbers without the subjects who started vaping after they had heart attacks, they found that "vapers were much less likely to have had a heart attack, not twice as likely."

In their study, Bhatta and Glantz acknowledged that "we cannot infer temporality from the cross-sectional finding that e-cigarette use is associated with having had an MI," and "it is possible that first MIs occurred before e-cigarette use." But instead of using the information provided by the survey to address that issue, they did a secondary analysis limited to subjects who had their first heart attacks in 2007 or later. They chose that year because it was when "e-cigarettes started gaining popularity on the US market."

Of course, that does not mean all 16 of the subjects in this sub-sample had heart attacks after they started vaping. In fact, Rodu and Plurphanswat found that it was the other way around in "more than a third" of those cases, as they noted in a follow-up letter yesterday. (They did not report the precise numbers because of limits on how PATH data can be used.) Even ignoring that crucial point, Bhatta and Glantz's secondary analysis did not find a statistically significant association between vaping and heart attacks.

When USA Today reporter Jayne O'Donnell asked Glantz about the glaring problems with his study, he bragged about being "a for-real rocket scientist," dismissed Rodu as a "tobacco industry apologist" because his research is supported by unrestricted grants from several tobacco companies, and claimed he and Bhatta would have found a statistically significant association if only the sample had been larger. But he conspicuously failed to address the puzzle of an effect that precedes its purported cause.

Rodu's interest in tobacco harm reduction long predates his receipt of industry funding, which he says he felt compelled to accept because government agencies refused to fund his research on smokeless tobacco as a safer alternative to cigarettes. In an interview with O'Donnell, New York University public health professor Ray Niaura, who said he does not think a connection between vaping and heart attacks has been established, vouched for Rodu, calling him a "fastidious scientist."

Glantz, it's fair to say, is a bit less fastidious. He has been slamming e-cigarettes as an evil tobacco industry plot for years, and he has repeatedly tried to cast doubt on the indisputable fact that they are much less hazardous than the conventional kind. "E-cigarettes should not be promoted or prescribed as a less risky alternative to combustible cigarettes," Bhatta and Glantz write, "and should not be recommended for smoking cessation among people with or at risk of myocardial infarction."

That conclusion is based on a study that considered only one of the risks posed by smoking and even then managed to imply equivalence only by ignoring obviously relevant information. "The main findings from the Bhatta-Glantz study are false and invalid," Rodu and Plurphanswat write in their July 11 letter to JAHA. "Their analysis was an indefensible breach of any reasonable standard for research on association or causation."

In their July 18 letter, they add: "Their inclusion of a secondary analysis is evidence that Bhatta and Glantz knew that many current e-cigarette users had a heart attack before they started vaping. The results of their secondary analysis confirm that their study results are false and invalid." They conclude by urging the journal's editors "to take appropriate action on this article, including retraction."

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  1. Rodu and Plurphanswat … found that “vapers were much less likely to have had a heart attack, not twice as likely.” Holy smokes!

  2. That’s some fine policy work there, Lou. You have a bright future as an expert witness for hire.

  3. Facts? We don’t need no stinkin’ facts!

    1. Personally, I’d love some stinkin’ facts. I noticed a couple of years ago that when I’d vape pot I’d get real dizzy. Not really high dizzy, like lack of blood to the brain dizzy. Then a couple of times I actually passed out. Again, not from being really high, just light-headed then next thing I knew my wife was slapping me in the face trying to wake me up. This resulted in a trip to the ER, followed by angioplasty and a couple of stents.

      This never happened/happens with just regular smoking, just with the vape. I haven’t seen anything about it on the web, and was sort hoping for some real info from this study. Too bad it sucks ass.

      1. You sound pre-diabetic.

      2. Flesh Rod, I have never heard of such a thing.

  4. Next month’s headline: “Scientists dismayed as public’s confidence in science dips lower.”

  5. Do I think that vaping is amazing for you? nope. Do I think it causes health issues? Probably some minor ones. Is it better than smoking? Undoubtedly. Not as good as not smoking anything but Jesus critical thinking is on a huge down swing.

  6. Asking Glantz ‘)or should I say Glans’) opinion on anything related to tobacco or nicotine is like asking Jerry Fallwell’s opinion on anything related to LGBTQ issues or contraception. Glans is an ideologue NOT a scientist (as this “study” proves) although he is fond of being referred to as doctor because he is a prof at UCSF medical school, even though he lacks a doctorate, never mind an MD.

    1. Wouldn’t it be a wonderful thing if a whole bunch of people got together and funded a class action lawsuit on behalf of the world population against UCSF and Glantz for fraud – he has no doctorate, MD or otherwise, there is bountiful proof of his dishonesty and the university that employs him hasn’t done a damn thing to stop it.

  7. Hmmm… releasing “studies” which conflict with their own data. Who does he think he is, the CDC?

  8. We are seeing the desperation of a whole generation of anti-smoking “advocacy scientists” (Oxymoron rating: 8) whose careers have been funded by the Big Tobacco master settlement. That money is going to go away and they can’t retire, sooo…we get shit like this.

    Note that the dynamic of “funding provided with the expectation of a certain result” for these guys is the same as Big Oil pollution studies and the original Big Tobacco studies on ‘health effects of tobacco”. Though I’d expect the science produced in the latter cases was always better than this shit.

    1. When industry hires scientists to do studies, they have to at least do enough work to make the show of it look good. Hiring smart people to perform the studies, methodologies that hold up to basic scrutiny even if they’re flawed at deeper, more complex levels in order to get favorable outcomes.

      When the scientists are funded by government, they can assume nobody even checks their work, as is apparent here.

  9. Rodu and Plurphanswat ought to take a look at the “settled science” on global cooling, which morphed into global warming, which morphed into climate change, over about the last 40 years.

  10. makes Glantz’s causal inference logically impossible

    Causal-logical inferences are the Devil’s work.

  11. It is a cross-sectional study. Those are not reliable in establishing causality because they only look at a population at one time. It is the weakest study in epidemiology.

    Consider averaging all NBA players for odds of achieving 3 point shots in a one week period. Then look at Steph Curry. You have really said nothing much about the game of basketball.

    Better would be a case control or cohort study over time.

  12. I really hate how Reason keeps shilling for the vape industry. Most people here believe vaping (or any recreational drug use) should be legal. That doesn’t mean we need to lie about the medical facts. Sure, they botched their study and the risk wasn’t as elevated, but if you’re suggesting that using a nicotine delivery system won’t give you an elevated risk of heart attacks relative to someone sober, you’re just a counter-factual idiot and a shill.

    1. Minor detail; it is not required to add nicotine to your vaping fluid. It can be done just for the flavor. But let’s just define a product with absolutely no tobacco as a tobacco product because we can. Science is a fraud.

    2. I don’t think anyone here has shilled for vaping, nor have they said it was harmless. The ones that hurt that fact more than anyone else, is the jack asses that put out false studies like this. Good for Reason on pointing out shills that all claim vaping is just as bad for you as smoking, when they have no actual facts that back up that hypothesis.
      Now it can be said that Reason is a “shill” for allowing grown ass adults make their own choices in what chemicals they put in their OWN bodies.

    3. Referring to those who don’t use nicotine at all as the “sober” cohort reveals something about YOU, that’s for sure.

  13. I’ll posit a causal effect that describes their data more closely by far: people who had prior heart attacks, knowing they’re at increased risk, switched to vaping when they heard data that vaping is less dangerous (though likely still more dangerous than quitting altogether) than continued smoking.

    Boom! Lots of people who switched to vaping have heart attacks!

  14. I think what needs to be considered now is a modern lifestyle that can affect our health. In conclusion, materials such as cigarettes or vape will be very dangerous if your lifestyle is irregular

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