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Walker J, et al. Cumulative Life’s Essential 8 Scores and Cardiovascular Disease Risk. JAMA Ca “We observed that increased cumulative cardiovascular health (CVH) from age 32 to 45 years, but not from age 18 to 31, was associated with lower incident CVD and mortality. This is consistent with the finding that a positive slope in CVH (as measured by Life Essential, LE 8 score) for the same cumulative score was associated with lower CVD and mortality risk.

This paradigm has been found in nicotine exposure, which is why “years since quitting” (in conjunction with pack-years) is clinically relevant.34-37”

“…cumulative LE8 score and positive slope of (improving) LE8 score from age 18 to 45 years were significantly associated with lower hazards for incident CVD after age 45.”

Note: The Life Essential 8 score measures 8 factors and indicates later CVD incidence and mortality (with smoking and low-density lipoprotein cholesterol (LDL-C) as essential factors for early intervention). However, this predictive element also applies to the LE8 score (a combined measure), as demonstrated here. Results emphasize the importance of maintaining and improving CVH throughout young adulthood, not just having a positive LE8 score at a given time. Thus, this score could urge early behavior change, a preventive intervention for later CVD. Stephen Hamann

TRC Research Commentary

Romeh M. Ali F., et al. Trends in U.S. E-cigarette Sales Measured in Milligrams of Nicotine, 2019–2024, American Journal of Preventive Medicine, 2025, ISSN 0749-3797,

https://doi.org/10.1016/j.amepre.2025.02.007.

https://www.sciencedirect.com/science/article/pii/S0749379725000522

“This study demonstrates the importance of revisiting approaches for measuring e-cigarette sales in a dynamic market. While most cigarettes in the U.S. are sold in packs of 20 sticks, a standard unit for e-cigarettes is less straightforward due to variations in product type (e.g., cartridge, disposable, refillable), volume, and nicotine concentration. Measuring e-cigarette sales by milligrams of nicotine sold better accounts for changes in device volume and nicotine concentration.

Nicotine content in e-cigarettes sold increased from 2022 to 2023, while standardized unit sales decreased. Nearly 90% of the nicotine content sold in 2023 was flavored to taste like something other than tobacco. Furthermore, by June 2024, e-liquid volume in a disposable device was 9.0 times that of a prefilled cartridge, up from 1.7 in February 2020. This study adds to previous findings of a declining price of nicotine in disposables by showing that nicotine is cheaper in disposable e-cigarettes compared to prefilled cartridges. This raises concerns; youth are particularly price-sensitive, and disposable e-cigarettes are the most popular e-cigarette product among youth.”

Comment: Nicotine content is associated with the rapid addiction seen in young populations. There is no standard e-cigarette, and nicotine boosting in disposable e-cigarettes makes addiction faster and more challenging to overcome. Stephen Hamann