A recent cohort study involving over 103,000 participants highlighted significant cardiovascular health risks associated with the use of noncigarette tobacco products, including cigars, pipes, and smokeless tobacco. 

The analysis pooled data from 15 U.S.-based prospective cohorts collected between 1948 and 2015, with a median follow-up of 13.8 years. Researchers accounted for demographic, socioeconomic, and cardiovascular risk factors to isolate the effects of noncigarette tobacco use, JAMA Network Open.

"Findings of our study support the view that the use of noncigarette tobacco products is associated with substantial harm, particularly from a cardiovascular point of view, although associations across specific products and specific outcomes were variable, with the smallest risk increases observed for pipes," noted Erfan Tasdighi, MD, of the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease in Baltimore, Maryland, and colleagues.

Key Findings

The analysis identified specific risks linked to different types of noncigarette tobacco products:

• Cigars: Current users exhibited a higher risk of stroke (HR 1.25; 95% CI, 1.01-1.55), atrial fibrillation (HR 1.32;  95% CI, 1.13-1.53), and heart failure (HR, 1.29; 95% CI, 1.10-1.51), compared with never uses. Sole and exclusive cigar use further heightened stroke risk.
  
  
• Pipes: The current use of pipes was tied to an increased risk of heart failure  (HR 1.23; 95% CI, 1.01-1.49), compared with never users. Sole pipe use correlated with myocardial infarction  (HR 1.43; 95% CI, 1.17-1.74) and other cardiovascular conditions, compared with never users.
  
  
• Smokeless Tobacco: Users faced elevated risks of coronary heart disease (HR 1.31; 95% CI, 1.08-1.59) mortality and myocardial infarction (HR, 1.20; 95% CI, 1.03-1.39), compared with never users. Sole and exclusive smokeless tobacco users experienced particularly pronounced risks, including an increase in "CVD mortality (HR, 1.34; 95% CI, 1.19-1.50 and HR, 1.34; 955 CI, 1.13-1.59, respectively), total coronary heart disease (HR, 1.41; 95% CI, 1.21-1.64 and HR, 1.36; 95% CI, 1.08-1.70, respectively), heart failure (HR, 1.41; 95% CI, 1.22-1.64 and HR, 1.70; 95% CI, 1.40-2.06, respectively), and cardiovascular (HR, 1.41; 95% CI, 1.20-1.65 and HR, 1.54; 95% CI, 1.24-1.91, respectively) and all-cause (HR, 1.46; 95% CI, 1.34-1.60 and HR, 1.39; 95% CI, 1.22-1.58, respectively), compared with never using smokeless tobacco or cigarettes," wrote the researchers.

The 103,642 participants had a mean age of 55.7 years with 47.8% being female. Current cigarette use was reported by 26.3%, cigar use by 2.1%, pipe use by 1.2%, and smokeless tobacco use by 12.1%.

Despite the declining prevalence of cigarette smoking, the use of alternative tobacco products remains steady or has risen, noted the researchers. The findings challenge the perception of cigars, pipes, and smokeless tobacco as "reduced-harm" options. Instead, the analysis demonstrated that these products carry significant cardiovascular risks, albeit generally lower than those associated with combustible cigarettes.

"Epidemiological insights from this study may support regulatory action relevant to new tobacco products or product standards and provide a framework for the future study of new and emerging tobacco products," the researchers concluded.

Author disclosures can be found in the published article.