Background Although use of electronic cigarettes (e‐cigarettes) is increasing, its cardiovascular impact remains uncertain, especially among stroke survivors. We compared the incidence of major cardiovascular events in stroke survivors according to cigarette/e‐cigarette use. Methods We conducted a retrospective cohort study of Korean men with acute stroke who underwent national health checkups within 3 years of the index stroke (2018–2022). The patients were categorized into 4 groups based on their cigarette/e‐cigarette use status: nonusers, combustible cigarette users, dual users (both combustible cigarettes and e‐cigarettes), and e‐cigarette‐only users. The primary outcome was a composite of recurrent stroke and myocardial infarction. Multivariable Cox models estimated hazard ratios (HRs) across groups. Results Of the 115 240 men with stroke, 89 326 (77.5%) were nonusers, 23 688 (20.6%) were combustible cigarette users, 1498 (1.3%) were dual users, and 728 (0.7%) were e‐cigarette‐only users. During a mean follow‐up of 2.61±1.46 years, 6722 patients suffered primary outcome events (ischemic stroke: 4799; hemorrhagic stroke: 1165; myocardial infarction: 758). Compared with nonusers, the risk of the primary outcome was higher in the combustible cigarette group (HR, 1.35 95% CI, 1.27–1.43) and dual users (HR, 1.27 95% CI, 1.01–1.60), whereas e‐cigarette‐only users showed a nonsignificant elevation (HR, 1.11 95% CI, 0.77–1.59). Conclusions Among Korean male stroke survivors, combustible cigarette use and dual use were associated with higher risk of recurrent stroke or myocardial infarction, whereas e‐cigarette‐only use was not significantly different from nonuse. Further research is warranted to clarify the long‐term cardiovascular effects of e‐cigarette use among stroke survivors.
Yoo et al. (Wed,) studied this question.