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Surveillance of e-cigarette use among different population groups is important for the timely implementation and evaluation of tobacco regulatory policies. In this review, we identified 13 nationally representative, repeatedly conducted epidemiologic surveys that assess e-cigarette use among U.S. youth and/or adults and have been instrumental in e-cigarette surveillance. These surveys included National Youth Tobacco Survey, Youth Risk Behavior Surveillance System, Monitoring the Future Survey, International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, Tobacco Use Supplement of the Current Population Survey, Health Information National Trends Survey, Tobacco Products and Risk Perception Surveys, ITC Four Country Smoking and Vaping Survey, National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and Population Assessment of Tobacco and Health. These surveys vary in scope and detail, with their unique strengths and the regulatory questions that can be answered using each survey data. We also highlighted the gaps in these surveys and made recommendations for improvement.

Introduction:Coronary artery calcification (CAC) is a noninvasive biomarker of atherosclerotic plaque burden in the general population and predicts coronary heart disease and mortality. This study examined whether CAC predicts stroke mortality independent of established traditional cardiovascular risk factors.Methods:We included 66,511 participants (mean age: 54.4±10.6 years; 33.0% women) from the prospective, multi-center CAC Consortium study without stroke or coronary heart disease (CHD). CAC was assessed at the study baseline with a cardiac-gated computed tomography scan and categorized as absent/present and 0, 1-99, 100-299, and ≥300 Agatston Units (AU). To examine CAC as a predictor for stroke mortality, we utilized multivariable-adjusted Fine and Gray competing risk regression models, adjusting for traditional cardiovascular risk factors. For sensitivity analysis, we excluded patients whose death certificates indicated a possible stroke-complication of CHD (excluded, n=8).Results:During a mean follow-up period of 12.3±3.9 years, there were 160 stroke deaths. Compared to individuals without CAC, those with CAC >0 AU had a higher incidence of stroke mortality (0.31 vs. 0.06 per 1,000 person-years). After adjusting for traditional risk factors, individuals with CAC had a significantly higher sub-distribution hazard ratio (SHR) for stroke mortality than those without CAC (SHR: 2.17; [95% CI:1.32-3.56). In addition, compared with individuals without CAC, the risk of stroke mortality significantly increased as CAC increased (SHR range:1.77; [95%CI: 1.03-3.05]) - 3.09; [95% CI:1.72-5.54]). The results obtained from our sensitivity analysis were similar (Table).Conclusions:CAC was associated with mortality from stroke independent of traditional cardiovascular risk factors. While a marker of coronary atherosclerosis burden, CAC should be considered a risk marker for all types of atherosclerotic cardiovascular disease mortality.

Introduction:Social environment and neighborhood factors, including perceived social cohesion, represent key determinants of health. While evidence has shown that low cohesion may be adversely associated with cardiovascular health and higher levels may be cardioprotective, few studies have assessed the association between cohesion and sociodemographic factors among adults with atherosclerotic cardiovascular disease (ASCVD).Methods:Using a U.S. nationally representative sample (National Health Interview Survey [NHIS], 2013-18), we examined the association between sociodemographic characteristics and neighborhood social cohesion in adults with ASCVD. Social cohesion was categorized based on the sum of the four subscales: 1) people in this neighborhood help each other out; 2) there are people I can count on; 3) people can be trusted; and 4) this is a close-knit neighborhood. The composite score was then split at or above and below the median.Results:Among 17,017 NHIS participants with ASCVD (representing 18.3 million adults annually), 8,988 (54%) reported low neighborhood social cohesion, corresponding to 9.9 million adults. A higher proportion of those aged 18-39 years (71%), non-Hispanic Black (67%) and Hispanic (68%) individuals, uninsured (71%) adults, and immigrants (65%) reported low social cohesion compared to other groups. In multivariable logistic regression, those aged 18-39 years and 40-64 years, non-Hispanic Black and Hispanic adults, individuals with a low-income, and immigrants had increased odds of low social cohesion (Figure). Overall, 80% of adults with 4 of these characteristics had low social cohesion.Conclusion:Sociodemographic factors are associated with disparities in neighborhood social cohesion among adults with ASCVD. Future studies should assess the causal relationship between social determinants and neighborhood cohesion, the consequences of low social cohesion, and potential approaches to ameliorate it.

•Aspirin use among adults in the US has slightly declined over the last decade•1 in 3 US adults aged ≥40 years reported aspirin use for ASCVD prevention in 2019•Approximately 45.6% of adults ≥70 years reported primary prevention aspirin use•Females were less likely than men to report secondary prevention aspirin use

Background:E-cigarettes delivers nicotine by heating a liquid derived from tobacco. The prevalence of e-cigarette use and is not well documented among US high schoolers.Aim:Description of e-cigarettes use among US high schoolers.Methods:We included 14,407 YBRFS 2017 participants with information on e-cigarette use. Current E-cigarette use was defined as any e-cigarette use in the last 30 days. Complex survey design was applied to ensure the national representation.Results:Among US high schoolers the prevalence of current e-cigarette use was 13.2% (CI, 11.4 - 15.2) and ever e-cigarette use was 42.2 (CI, 39.3 - 45.2) corresponds to 2.2 million current and 7.1 million ever high schooler e-cigarette users in the United States. The prevalence of current e-cigarette use was higher among men 15.9% (CI, 13.8 - 18.2), compared to women 10.5% (CI, 8.8 - 12.6). Native Americans had the highest prevalence of current e-cigarette use among different racial/ethnicities followed by Caucasians. (Table)E-cigarette use has extended to never-smokers, with more than one-fourth of adolescents (26.2% (CI, 23.9 - 28.6)) without any history of combustible cigarette smoking experimented with e-cigarettes. The prevalence of current and ever e-cigarette use increased with increasing age. Across age groups, the prevalence of current e-cigarette use was highest among those aged 18 years (21.6% [CI, 18.8% to 24.7%]).Conclusions:E-cigarette use is very common among US high schoolers with more than 2 million current users. The popularity of e-cigarettes among adolescents might reverse decades of public health campaigns to combat cardiovascular harm of tobacco products.

Introduction:Coronary Artery Calcium (CAC) testing is an important risk stratification tool with guideline endorsement for shared decision making in asymptomatic individuals aged 40-75 years, free of atherosclerotic cardiovascular disease (ASCVD), with 10-year ASCVD risk of 5-20%. While there is emerging data on CAC in those age 30-49 years, limited data are available on the prevalence of CAC among adults <30 years. We studied the prevalence of CAC and assessed the association between ASCVD risk factor burden and CAC in this age group.Methods:The CAC Consortium, a large multi-center cohort of 66,636 patients enrolled asymptomatic patients aged 18 years or older without a history of coronary heart disease at the time of CAC scan, who were referred for risk stratification. We studied 373 young adults aged 20-30 years from the CAC Consortium. We described ASCVD risk factor burden (history of smoking, diabetes, hypertension, hyperlipidemia and family history of coronary heart disease) by CAC category (CAC=0; CAC >0). The association between ASCVD risk factor burden and CAC was assessed using age- and sex-adjusted multivariable logistic regression models.Results:Mean age of the study sample was 27.5 +2.4 years. Of 373 patients, 324 (86.9%) had CAC=0 and 49 (13.1%) had CAC >0. Among patients with CAC, 38 (77.6%) were men.While 63.6% of those with CAC=0 had <1 risk factors, 42.8% of those with CAC >0 had <1 risk factors. Patients with >3 ASCVD risk factors (32 patients, 8.6%) had a statistically significant higher odds of CAC > 0 compared to patients with no risk factors (OR 5.57, 95% CI; 1.82-17.03).Conclusion:In a sample of young adults aged 20-30 years old prevalence of CAC was 13.1%. Number needed to scan to detect CAC was 8. There was generally a graded increase in odds of CAC > 0 with increasing number of ASCVD risk factors. Patients with >3 ASCVD risk factors, while just 8.6% of the population, had the highest odds of CAC >0 compared to patients with no ASCVD risk factors.

Introduction:Coronary artery calcium (CAC) is a strong predictor of future cardiovascular disease (CVD) events including among adults in the intermediate risk group of ASCVD 7.5-20%. The 2018 AHA/ACA cholesterol guideline recommended discussion on statin initiation for patients aged 40-75 years with an ASCVD risk of 5-7.5% (?borderline risk group?) in the presence of risk enhancers. We examined whether CAC can further stratify cardiovascular risk in this group and can therefore be used to inform initiation of statin therapy.Methods:We studied 8,939 adults with an ASCVD risk score of 5-7.5% from the CAC Consortium, a large multi-center cohort of asymptomatic patients free of clinical CVD at baseline who were clinically referred for CAC-based risk stratification. We assessed the predictive value of CAC for coronary heart disease (CHD) and CVD mortality using multivariable Cox proportional hazards regression models adjusted for age, sex, and traditional risk factors, among the study population overall, and then among those aged 40-75 years.Results:Mean age of the study population was 55.9 years. Over a mean follow up of 12.6?3.7 years, there were 32 CHD and 72 CVD deaths. Participants with CAC=0 had low absolute mortality rates compared to those with CAC?400 (CHD - 0.12 vs 0.82 per 1000 person-years; CVD - 0.37 vs 1.55 per 1000 person-years, respectively). Increasing CAC scores (reference CAC=0) were associated with increasing CHD and CVD mortality [CHD - CAC 100-399: Hazard ratio (95% confidence interval) 3.24 (0.98-10.7), CAC?400: 6.10 (1.84-20.2); CVD - CAC 100-400: 2.17 (1.02-4.63), CAC?400: 4.55 (2.21-9.39)]. Similar results were seen for patients aged 40-75 years.Conclusions:CAC risk-stratifies adults in the borderline ASCVD risk group of 5-7.5%. Thus, CAC can help guide risk discussion of moderate-intensity statin therapy for adults at borderline ASCVD risk.

Introduction:Risk stratification is important to determine appropriate preventive strategies for patients at risk for cardiovascular disease (CVD). Although coronary artery calcium (CAC) has proven to be a strong prognosticator of coronary heart disease (CHD) risk, the role of thoracic aortic calcification (TAC) for the prediction of CVD and all-cause mortality has not been clearly elucidated.Methods:We studied data from CAC Consortium, a large multi-center cohort of 66,636 asymptomatic individuals 18 years or older with no history of coronary heart disease (CHD) and asymptomatic at the time of CT scan. We included 41,066 individuals with available TAC data. We ran multivariable cox regression models adjusted for age, sex, smoking status, hyperlipidemia, hypertension, diabetes, family history of premature CHD, and log-transformed CAC (logCAC) for the prediction of CHD, CVD, and all-cause mortality, and reported hazard ratios (HR) with 95% CI. We performed c-statistic to report area under the receiver operating characteristic curve (ROC) for models with and without logCAC.Results:Mean age was 53.8 ? 20.6 years, with 34.4% female. Prevalence of CAC and TAC were 21,590 (52.6%) and 11,684 (28.5%), respectively. TAC was present among 11.7% participants without CAC. TAC was more prevalent among those with diabetes (47.5%) than hypertension (41.9%), hyperlipidemia (33.6%), and among current smokers (32.1%). Over a median follow up of 11.6 years, presence of TAC at baseline was associated with CHD death (HR=1.48, 1.16-2.0), CVD death (HR=1.77, 1.42-2.21), and all-cause mortality (HR=1.36, 1.21 - 1.52). The addition of TAC to traditional risk factors and CAC significantly increased area under ROC for CVD death and all-cause mortality. (Table)Conclusions:TAC was noted to predict the risk for CVD death among asymptomatic individuals independent of traditional risk factors and CAC. More studies are needed to evaluate the clinical value of TAC in risk prediction.