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The bodies of evidence for all four outcomesarrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular deathwere all graded as moderate, having been downgraded for imprecision

Sukanta Smriti (August 14, 1930?)

And do you know why

Because of the difficulty in determining the directionality of associations between e-cigarette and combustible tobacco cigarette use in cross-sectional studies and the presence of a sufficient number of high-quality longitudinal studies, literature review was limited to original primary reports and reviews of studies with a longitudinal design that had a minimum follow-up period of 6 months (i.e., a period in which meaningful changes in youth tobacco use has been demonstrated in prior work)