Noncigarette tobacco products carry distinct health risks

The use of noncigarette tobacco products is associated with distinctive cardiovascular outcomes, including stroke for cigar, heart failure for pipe, and total cardiovascular disease (CVD) for smokeless tobacco, as shown in a study.

Researchers conducted the study within the Cross Cohort Collaboration Tobacco Working Group by harmonizing tobacco-related data and conducting a pooled analysis from 15 US-based prospective cohorts. Outcomes were examined in relation to current, sole, and exclusive use of noncigarette tobacco products. Sole use was defined as use of a noncigarette tobacco product without currently smoking cigarettes, while exclusive use meant using only the noncigarette tobacco product and never having smoked cigarettes.

The total study population consisted of 103,642 participants (mean age 55.7 years, 47.8 percent female). Outcomes included myocardial infarction, stroke, heart failure, atrial fibrillation, total coronary heart disease, total CVD, coronary heart disease mortality, CVD mortality, and all-cause mortality. The median follow-up time for the all-cause mortality outcome was 13.8 years.

A total of 26,962 participants (26.3 percent) reported current use of cigarettes, 1,147 (2.1 percent) reported current use of cigars, 530 (1.2 percent) reported current use of pipes, and 1,410 (2.1 percent) reported current use of smokeless tobacco.

Compared with never use, current cigar use was associated with stroke (hazard ratio [HR], 1.25), atrial fibrillation (HR, 1.32), and heart failure (HR, 1.29). A positive association with stroke was also seen for sole (HR, 1.34) and exclusive (HR, 1.53) cigar use.

Current pipe use showed an association with heart failure (HR, 1.23), while sole pipe use was linked to myocardial infarction (HR, 1.43) relative to never use of pipes or cigarettes.

Finally, current use vs never use of smokeless tobacco was associated with coronary heart disease mortality (HR, 1.31) and myocardial infarction (HR, 1.20). Sole and exclusive smokeless tobacco use showed associations with total CVD (HR, 1.34 and HR, 1.34, respectively), total coronary heart disease (HR, 1.41 and HR, 1.36, respectively), heart failure (HR, 1.41 and HR, 1.70, respectively), cardiovascular mortality (HR, 1.41 and HR, 1.54, respectively) and all-cause mortality (HR, 1.46 and HR, 1.39 respectively).

The present data have important implications for public health and regulation of noncigarette tobacco products, the researchers said.