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E-cigarettes may not be as harmless as many people think. A new study suggests they significantly increase the risk for heart attack.

Combined data from two national surveys of more than 69,000 people 18 and older carried out in 2014 and 2016 showed that compared with people who never used e-cigarettes, daily users almost doubled their risk for heart attack.

Cigarette smoking alone nearly triples the risk for heart attack. But more than 66 percent of e-cigarette users also smoked cigarettes, and in those people the risk of heart attack was nearly five times the risk of nonsmokers.

The study, in the American Journal of Preventive Medicine, controlled for age, sex, body mass index, high blood pressure, high cholesterol and diabetes.