Dual use of electronic and conventional cigarettes is associated with higher cardiovascular risk factors in Korean men

Sci Rep. 2020 Mar 27;10(1):5612. doi: 10.1038/s41598-020-62545-3.


Most smokers who use electronic cigarettes (e-cigarettes) to stop smoking simultaneously use conventional cigarettes (dual users). We aimed to compare the prevalence of cardiovascular risk factors among dual users, cigarette-only smokers, and never smokers in Korean men. We used data acquired from Korean National Health and Nutrition Examination Survey (2013-2017) pertaining to 7,505 male participants aged 19 years or older. About 85% of e-cigarette users were dual users. Dual users had greater nicotine dependence and higher urinary cotinine levels than cigarette-only smokers. Dual users had more psychosocial and behavioural risk factors, including perceived high stress, depressive mood, high daily intake of energy, and obesity, than never smokers and cigarette-only smokers. The prevalence of metabolic syndrome (MetS) was higher among dual users, and their multivariate-adjusted prevalence odds ratio for MetS was 2.79 (P < 0.001) compared with never smokers and 1.57 (P = 0.038) compared with cigarette-only smokers. Given that most e-cigarette users are dual users and dual users are more vulnerable to cardiovascular risk factors than cigarette-only smokers and never smokers, more active treatment for smoking cessation and intensive lifestyle interventions for dual users should be considered with priority.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiovascular Diseases / etiology*
  • Cigarette Smoking / adverse effects*
  • Electronic Nicotine Delivery Systems
  • Electronics / methods
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • Republic of Korea
  • Risk Factors
  • Smokers
  • Surveys and Questionnaires
  • Tobacco Products / adverse effects*
  • Tobacco Use Disorder / etiology
  • Young Adult