Findings Show Noncigarette Tobacco Use Associated With Cardiovascular Risks

Results of a study published in JAMA Network Open show distinctive cardiovascular risks associated with noncigarette tobacco products, including cigars, pipes, and smokeless tobacco. Smoking is a major cause of cardiovascular disease (CVD), and exposure to secondhand smoke can also cause heart disease and stroke, according to the CDC.^1,2

Smokeless Tobacco, Tobacco, Cardiovascular, Heart Health | Image Credit: zadveri | stock.adobe.com

Smoking accounts for approximately 1 in every 4 CVD-related deaths, increasing the risk of atherosclerosis, coronary heart disease (CHD), heart attack, sudden cardiac death, stroke, peripheral arterial disease, and abdominal aortic aneurysm. Smoking is also known to raise triglycerides, lower high-density lipoprotein, make blood more likely to clot, damage cells that line the blood vessels, build up plaque, and cause thickening and narrowing of blood vessels. According to the CDC, quitting is one of the biggest ways to reduce risk of CVD and death—regardless of age or length of time someone smoked.²

Community pharmacists play an essential role in smoking cessation. In a study from UC Davis, a total of 22 California-based pharmacists and 26 pharmacy technicians trained in tobacco cessation. As part of the training, pharmacists completed 2 hours of training and followed state-approved protocols, including reviewing current tobacco use, prior quit attempts, screening, proving medication counseling, and addressing or referring patients to behavioral counseling. The results showed that tobacco cessation was successfully implemented across the pharmacies.³

In the JAMA Network Open study, investigators used data from 15 National Institutes of Health National Heart, Lung, and Blood Institute prospective cohorts that included tobacco-related data. They aimed to estimate the cardiovascular outcomes associated with the use of cigar, pipes, and smokeless tobacco compared with tobacco nonuse.¹

The investigator used the Cross Cohort Collaboration Tobacco Working Group (CCC-Tobacco), which included datasets form 23 cohorts and 322,782 individuals were included. Thirteen of the cohorts consisted of traditional cardiovascular cohorts and 10 were non-cardiovascular cohorts that studied aging. For this study, investigators used a subset of 15 CCC-Tobacco cohorts that had data on at least 1 noncigarette tobacco product, and data ranged from 1948 and 2015. Investigators gathered noncigarette tobacco product use from detailed questionnaires given to the cohorts, and they looked at a total of 9 related cardiovascular outcomes, including myocardial infarction, stroke, heart failure, atrial fibrillation, total CHD, total CVD, CHD mortality, CVD mortality, and all-cause mortality.¹

There were 103,642 individuals, with a mean age of 55.7 years, and 47.8% were female, and 61.8% were White. Approximately 26.3% reported current combustible cigarette smoking, 2.1% were current cigar users, 1.2% were current pip users, and 2.1% were current nonsmoking tobacco users. Those who used smokeless tobacco had a more adverse cardiometabolic profile, according to the study authors.¹

Investigators found that current cigar use was positively associated with 6 of the 9 outcomes compared to individuals who never smoked a cigar. Cigar use was associated with stroke, atrial fibrillation, and heart failure. For individuals using pipes, the only association was heart failure. Smokeless tobacco showed a positive association with 8 of the 9 outcomes, showing that CHD mortality had a hazard ratio (HR) of 1.31 (95% CI, 1.08-1.59), CVD mortality had an HR of 1.23 (95% CI, 1.07-1.41), and myocardial infarction had an HR of 1.20 (95% CI, 1.03-1.39). The analysis also showed that cigarette smoking was consistently associated with a higher risk across all measured outcomes.¹

For the sole use of cigars, there was a positive association with stroke CVD, and heart failure, with a notable increase for stroke and CVD compared to those who never smoked cigars or cigarettes. For individuals using only pipes, investigators found a significant increase in risk for myocardial infarction, CHD, and heart failure, with only a positive association for myocardial infarction compared with those who never smoked pipes or cigarettes. Furthermore, for those who used smokeless tobacco, there was an association with CVD, myocardial infarction, CHD, heart failure, CVD mortality, and all-cause mortality, with an increased risk of CHD mortality, CVD mortality, heart failure, and CVD risk compared with those who never smoked cigarettes or used smokeless tobacco.¹

REFERENCES

1. Tasdighi E, Yao Z, Jha KK, et al. Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration. JAMA Netw Open. 2025;8(1):e2453987. doi:10.1001/jamanetworkopen.2024.53987

2. CDC. Health effects of cigarettes: cardiovascular diseases. Accessed January 17, 2025. https://www.cdc.gov/tobacco/about/cigarettes-and-cardiovascular-disease.html

3. Winn S. New study confirms community pharmacies can help people quit smoking. UC Davis Health. April 19, 2024. Accessed January 17, 2025. https://health.ucdavis.edu/news/headlines/new-study-confirms-community-pharmacies-can-help-people-quit-smoking/2024/04