Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 8(1), e2453987. https://doi.org/10.1001/jamanetworkopen.2024.53987 Dr. Erfan Tasdighi et al.
Points
- This large cohort study followed over 103,000 participants for nearly 14 years to assess the cardiovascular effects of noncigarette tobacco use, including cigars, pipes, and smokeless tobacco.
- Current cigar users faced significantly higher risks of stroke, atrial fibrillation, and heart failure, with exclusive or sole cigar use notably linked to increased stroke risk compared to non-users.
- Sole pipe use was associated with elevated risks of heart failure and myocardial infarction, highlighting the cardiovascular dangers of smoking pipes even without concurrent cigarette use.
- Smokeless tobacco use was tied to increased risks of coronary heart disease mortality, myocardial infarction, total cardiovascular disease, heart failure, and all-cause mortality, especially among exclusive or sole users.
- These findings underscore the need for public health policies to address the underestimated cardiovascular harms of noncigarette tobacco products, even among individuals who do not smoke cigarettes.
Summary
This cohort study, conducted across 15 US-based prospective cohorts, evaluated the cardiovascular risks associated with noncigarette tobacco products, including cigars, pipes, and smokeless tobacco. The study analyzed data from 103,642 participants with a median follow-up of 13.8 years. The study found that current cigar use was associated with increased risks of stroke (hazard ratio [HR], 1.25; 95% confidence interval [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). Additionally, exclusive cigar use (HR, 1.53; 95% CI, 1.20-1.96) and sole cigar use (HR, 1.34; 95% CI, 1.12-1.62) were significantly associated with stroke risk compared to non-users.
Further, pipe use was linked to an increased risk of heart failure (HR, 1.23; 95% CI, 1.01-1.49) and myocardial infarction (HR, 1.43; 95% CI, 1.17-1.74) for sole pipe users, relative to non-users. Smokeless tobacco use was also associated with elevated cardiovascular risks, including coronary heart disease mortality (HR, 1.31; 95% CI, 1.08-1.59) and myocardial infarction (HR, 1.20; 95% CI, 1.03-1.39). Moreover, both sole and exclusive smokeless tobacco use were significantly associated with higher risks for total cardiovascular disease (HR, 1.34; 95% CI, 1.19-1.50), heart failure (HR, 1.41; 95% CI, 1.22-1.64), and all-cause mortality (HR, 1.46; 95% CI, 1.34-1.60).
This study highlights the distinctive cardiovascular risks posed by noncigarette tobacco products, emphasizing the need for public health measures to address these risks. The findings indicate that even in the absence of cigarette use, noncigarette tobacco consumption is associated with significant adverse cardiovascular outcomes. Future regulatory and public health strategies should consider these findings to mitigate the impact of noncigarette tobacco use on cardiovascular health.
Link to the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829075
References Tasdighi, E., Yao, Z., Jha, K. K., Dardari, Z. A., Osuji, N., Rajan, T., Boakye, E., Rodriguez, C. J., Matsushita, K., Simonsick, E. M., Lima, J. A. C., Widome, R., Cohen, D., Appel, L. J., Khera, A., Hall, M. E., Judd, S., Cole, S. A., Ramachandran, V. S., … Blaha, M. J. (2025). Cigar, pipe, and smokeless tobacco use and cardiovascular outcomes from cross cohort collaboration. JAMA Network Open, 8(1), e2453987. https://doi.org/10.1001/jamanetworkopen.2024.53987
