Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Abstract

on behalf of the American Heart Association Council on Cardiovascular Nursing V arious forms of smokeless tobacco (ST) products (snuff, chewing tobacco) are used by individuals of all ages. Over the past several years, US tobacco companies have expanded marketing and promotion of ST products. A major aim of this statement is to review and summarize the scientific evidence regarding ST product use and the potential cardiovascular risks associated with ST product use that can be used to inform policy related to tobacco control and strategies related to tobacco harm reduction. A specific policy question is whether ST products should be recommended to smokers instead of cigarettes to reduce the morbidity and mortality associated with smoking and/or as an approach to enhance smoking cessation. Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy. Based on the findings reviewed in this statement, clinicians should continue to discourage use of all tobacco products and emphasize prevention of smoking initiation and smoking cessation as primary goals for tobacco control.In the United States, various forms of ST products (snuff, chewing tobacco) are used by individuals of all ages, including adolescents and young adults.

Electronic Cigarettes

“…These studies report only a very small cardiovascular disease risk in snus users compared with tobacco smokers. 71 However, discontinuation of snus use after MI has been found to be associated with nearly halved mortality risk, which is similar in magnitude to the benefit associated with smoking cessation. 72 Thus, although the adverse health effects of e-cigarettes are not known, they are likely to be much less than those of cigarette smoking, but could be significant in individuals with heart disease.…”

Hypertension and Its Socioeconomic Factors in a Market Population in Awka, Nigeria

“…Nevertheless, tobacco snuff contains nicotine and potash both of which have been reported to influence blood pressure. [32,35] Arterial wall thickening, as in this study, has been documented as a risk factor of cardiovascular disease. [26] …”

Evaluating the Effectiveness of a One Point Psycho-Educational Intervention for Smokeless Tobacco Users Delivered in an Outpatient Department in India

“…As SLT has high nicotine content which is a very addictive drug, it has been observed that when a person tries to stop SLT use, he develops withdrawal symptoms and most of the people then restart SLT. This leads to a vicious cycle and the person chronically consumes SLT [5].…”

“…3) It can cause increased CV mortality by causing a dual smoking pattern in patients already smoking tobacco [5,8].…”