Smokeless tobacco products are not safer alternatives to cigarette smoking, do not help smokers quit, and their long-term use can, in fact, increase the risk of fatal heart attack, fatal stroke and cancer, the American Heart Association warned in a scientific statement published online Sept. 13.
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Long-term use of smokeless tobacco products, including snuff, are not safer alternatives to cigarette smoking and can increase the risk of fatal heart attack, fatal stroke and cancer, according to the American Heart Association.
The researchers, led by Mariann R. Piano, Ph.D., examined several international studies to compare smokeless tobacco use and its health risks. Metaanalysis data involving male, Swedish smokers from 1976-2002 showed a significant decrease in cigarette smoking that corresponded with an increase in use of smokeless tobacco products, the investigators wrote in the AHA journal, Circulation. Despite the decline in cigarette use, concern is warranted, Dr. Piano, professor of biobehavioral science at the University of Illinois at Chicago, explained: “Smokeless tobacco products are harmful and addictive – that does not translate to a better alternative,” Dr. Piano, said in a written statement released by the AHA.
“Scientists and policy makers need to assess the effect of ‘reduced risk’ messages related to smokeless tobacco use on public perception, especially among smokers who might be trying to quit,” Dr. Piano and her colleagues wrote. Citing “inadequate evidence of smoking cessation efficacy and safety,” the researchers deemed as inappropriate the promotion of smokeless tobacco as a way to reduce smoking-related diseases.
The American Heart Association does recommend nicotine replacement therapy (nicotine gum or a nicotine-releasing patch placed on the skin) as a safer option for cigarette smokers wanting to quit. “Clinical studies have found no increased risk of heart attack or stroke with either type of nicotine replacement therapy,” the AHA statement said in the written statement.
Metaanalysis data in the AHA scientific statement indicated that smokeless tobacco use was associated with an increased risk of heart disease (relative risk 1.12, n=8 studies) (Int J Epidemiol. 2007;36:789–804). Additionally, a subanalysis of INTERHEART (a study of 15,152 cases of first myocardial infarction in 52 countries) showed that tobacco chewers had a significantly increased risk of first myocardial infarction (odds ratio 2.23) compared with those who never used tobacco. Two other metaanalyses indicated that smokeless tobacco use was also associated with an increased risk of fatal stroke (RR 1.42, n=5 studies, and RR 1.40, n=5 studies).
The researchers explained that, like cigarettes, smokeless tobacco (ST) products still contain nicotine of varying concentrations as well as a number of carcinogens that are just as harmful. Cigarettes and oral snuff have similar amounts of nicotine (milligrams per gram of tobacco), while chewing tobacco appears to have “somewhat lower” amounts compared with cigarettes, Dr. Piano and her colleagues wrote. “Even though certain manufacturing techniques are used to reduce the level of these compounds in some products, they remain present in substantial concentrations in ST products, including Swedish snus,” they said.
In a comparison of nicotine concentration between three types of smokeless tobacco products (chewing tobacco, dry snuff, and moist snuff) and cigarettes sold in the United States, all of the smokeless tobacco products had nicotine concentrations that were similar to cigarettes with the highest concentrations (see chart).
Dr. Piano and her colleagues found that unlike the aforementioned Swedish cohorts, there was no reduction in smoking rates among people in the United States using smokeless tobacco. (The sale of smokeless tobacco products such as moist snuff or snus is banned in most of the European Union with the exception of Sweden and Norway.)