Smokeless tobacco, sport and the heart

Abstract

Smokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation and could therefore promote premature atherogenesis. At rest, heart rate, blood pressure, inotropism, cardiac output and myocardial oxygen consumption are increased by nicotine, leading to an imbalance between myocardial oxygen demand and supply. The same occurs at submaximal levels of exercise. These increases are accompanied by a rise in systemic resistances. At maximal exercise, heart rate, cardiac output and maximal oxygen uptake (V˙O2max) are unaffected by nicotine. Because endothelial dysfunction is promoted by nicotine, paradoxical coronary vasoconstriction may occur during exercise and recovery. Nicotine induces a decrease in muscular strength and impairs anaerobic performance. However, nicotine is used in sports as it diminishes anxiety, enhances concentration and agility, improves aerobic performance and favours weight control. Importantly, smokeless tobacco, similar to cigarette smoking, leads to nicotine dependence through dopaminergic pathways. Smokeless tobacco has harmful cardiovascular effects and is addictive: it fulfils all the criteria for inclusion in the World Anti-Doping Agency prohibited list as a doping product. Smokeless tobacco use in sporting activities must be discouraged.

Electronic cigarette exposure reduces exercise performance and changes the biochemical profile of female mice

“…Higher plasma catecholamine levels are associated with nicotine infusion during exercise and may lead to hemodynamic modifications effects that can compromise myocardial and muscular vascularization. Muscular strength may be impaired and the anaerobic threshold reached earlier [27]. Similarly, we also found that EC exposure decreased liver glycogen storage, in agreement with a previous study demonstrating that diabetic rats exposed to cigarette during pregnancy were impaired in their liver glycogen storage [28].…”

Smoking habits of italian athletes undergoing anti‐doping control

“…[10,13] Regarding the use of smokeless tobacco (e.g. snus) or electronic cigarettes, products which allow the stimulating benefits of nicotine without impacting the respiratory capacity, [14,15] no information was available for examined athletes regarding their smoking habits. Up to now, snus products are not distributed in Italy and according to 2014 Annual Survey on Smoking Status of the Italian population just 1.6% of Italian smokers use electronic cigarettes.…”

Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review

“…This followed a study investigating athlete nicotine usage at the 2009 World Ice Hockey Championships (Marclay & Saugy, ) and seemed to reflect a trend of increasing nicotine usage in athlete populations as reported in other studies (Hu et al ., ; Morrell et al ., ; Alaranta et al ., ; Martinsen & Sundgot‐Borgen, ). While these studies did not investigate routes of administration, other studies suggest smokeless forms of tobacco (SLT) are gaining favour in athlete populations (Hu et al ., ; Alaranta et al ., ; Martinsen & Sundgot‐Borgen, ; Chague et al ., ). This increasing trend of SLT may in part reflect decreases in smoking practices amongst athletes (Morrell et al ., ; Alaranta et al ., ; Norberg et al ., ) while also representing a belief that SLT have performance‐enhancing properties (Chague et al ., ).…”

“…While these studies did not investigate routes of administration, other studies suggest smokeless forms of tobacco (SLT) are gaining favour in athlete populations (Hu et al, 1995;Alaranta et al, 2006;Martinsen & Sundgot-Borgen, 2014;Chague et al, 2015). This increasing trend of SLT may in part reflect decreases in smoking practices amongst athletes (Morrell et al, 2005;Alaranta et al, 2006;Norberg et al, 2011) while also representing a belief that SLT have performanceenhancing properties (Chague et al, 2015).…”

“…However, nicotine inhalers, oral and nasal sprays and lozenges are now easily accessible (Carson et al, 2013). These new routes have not been evaluated in previous reviews (Heishman et al, 2010;Chague et al, 2015). Newer routes may have fewer side effects such as nausea and dizziness, which are particularly common when using snus (chewing tobacco) in nicotine-na€ ıve patients (Morente-Sanchez et al, 2015).…”