{
  "abstract": "Background Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes, are increasingly used worldwide, yet their association with major adverse cardiovascular outcomes remains inconclusive.Methods We conducted a systematic review and meta-analysis (PROSPERO: CRD420201026677) in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Scopus were searched up to May 10, 2020. Eligible studies included adolescents (13–18 years) and adults (≥19 years) using ENDS, reporting outcomes on any of the following: non-fatal myocardial infarction (MI), stroke, coronary artery disease (CAD), or cardiovascular mortality. The pooled odds ratios (ORs) were estimated using random-effects models and were considered the primary effect measures for assessing cardiovascular risk across exposure groups. Pooled outcome proportions were reported as secondary measures, reflecting the prevalence of outcomes within the ENDS-exposed population.Results Twenty-six studies, comprising over 900,000 ENDS users, were analyzed. The meta-analyses showed significantly higher pooled odds of coronary heart disease (OR = 1.19, p < 0.0001), major adverse cardiovascular events (MACE) (OR = 1.57, p < 0.0001), and stroke (OR = 1.62, p < 0.01). The greatest risk was observed among dual users (OR = 2.21, p < 0.0001.), indicating additive cardiovascular harm associated with combined use. All outcomes demonstrated substantial heterogeneity between-study variability.Conclusion ENDS use is associated with potential cardiovascular harm, particularly regarding stroke and non-fatal MI; however, the overall findings are limited by substantial heterogeneity. Associations with CAD and mortality remain inconclusive due to data limitations. High-quality longitudinal studies are needed to clarify the long-term cardiovascular risks of ENDS, which could ultimately guide public health policies and initiatives.",
  "authors": [
    {
      "affiliations": [
        "Imam Al-Sadiq Teaching Hospital, Coronary Care Unit, Babylon, Iraq"
      ],
      "name": "Suraa Al-Rubaye"
    },
    {
      "affiliations": [
        "University of Baghdad College of Medicine, Baghdad, Iraq"
      ],
      "name": "Mohammed Shweliya"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Alexandria University, Alexandria, Egypt"
      ],
      "name": "Mohamed Hemida"
    },
    {
      "affiliations": [
        "Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine"
      ],
      "name": "Mohammad Bdair"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Tanta University, Tanta, Egypt"
      ],
      "name": "Amr Abou Elezz"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Menoufia University, Menoufia, Egypt"
      ],
      "name": "Mohamed Shehab"
    },
    {
      "affiliations": [
        "The University of Tennessee Health and Science Center,, Tennessee, United States"
      ],
      "name": "Yara Abukhaled"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Al-Karkh General Hospital,, Baghdad, Iraq"
      ],
      "name": "Abdulrahman Al-waeli"
    },
    {
      "affiliations": [
        "Privolzhsky Research Medical University, Nizhny Novgorod, Russia"
      ],
      "name": "Abdullah Al-Tuaama"
    },
    {
      "affiliations": [
        "Babylon University, College of Medicine, Babylon, Iraq"
      ],
      "name": "Abbas Abdul Hussein"
    },
    {
      "affiliations": [
        "Al-kindy College of Medicine University of Baghdad, Baghdad, Iraq"
      ],
      "name": "Khadeeja Hamzah"
    },
    {
      "affiliations": [
        "Keele Cardiovascular Research Group, Faculty of Medicine & Health Sciences,, keele, United Kingdom",
        "Honorary Clinical Lecturer, Institute of Health Sciences Education, Queen Mary University of London, london, United Kingdom",
        "Honorary Research Fellow, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, manchester, United Kingdom",
        "Academic Clinical Fellow in Cardiology, NIHR Academy, National Institute for Health & Care Research,, Leedsd, United Kingdom",
        "Cardiology Department, Royal Stoke University Hospitals, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom"
      ],
      "name": "Mustafa Al-Jarshawi"
    }
  ],
  "title": "152 Association between electronic nicotine delivery systems (ENDS) use and major adverse cardiovascular events (MACE): a systematic review and meta-analysis",
  "uid": "bc6d3c47-1367-5677-8797-bb0ab7d742a6"
}