Noncombustible Nicotine or Tobacco Product and CVD Risk

Oct 12, 2021
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Authors:
Choi S, Lee K, Park SM.
Citation:
Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study. Circulation 2021;Oct 4:[Epub ahead of print].
Summary By:
Ragavendra R. Baliga, MBBS, FACC

Quick Takes

  • Transitioning to noncombustible nicotine or tobacco products (NNTPs) among combustible cigarette (CC) smokers may result in lower CVD risk compared with continued combustible-only use.
  • NNTP use on combustible cessation was associated with higher CVD risk compared with combustible cigarette cessation without noncombustible nicotine or tobacco products.
  • Although NNTPs may have lower CVD risk than combustible cigarettes, quitters of CCs who use noncombustible nicotine or tobacco products may be exposed to higher CVD risk than those who quit CCs without NNTP use.

Study Questions:

Is there a difference in cardiovascular disease (CVD) risk between initial combustible cigarette (CC) smokers who transitioned to noncombustible nicotine or tobacco product (NNTP) use compared with continuing CC-only smoking, and is there a difference with the CVD risk on CC cessation according to NNTP use?

Methods:

The study cohort consisted of 5,159,538 adult men who underwent health screening examinations during both the first (2014–2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. The study authors divided the cohort into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. They utilized propensity score matching analysis to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. The authors utilized multivariable Cox proportional hazards regression to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to changes in NNTP and CC smoking habits.

Results:

The study authors found that when compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79–0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78–0.84]) had lower risk for CVD. CC and NNTP users (aHR, 0.84 [95% CI, 0.80–0.89]), recent CC quitters with NNTP use (aHR, 0.77 [95% CI, 0.66–0.91]), and long-term CC quitters without NNTP use (aHR, 0.63 [95% CI, 0.62–0.65]) had lower CVD risk than continual CC-only smokers. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01–1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Also, when compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07–2.72]) had higher CVD risk. Compared with continual CC-only smokers, CC and NNTP users had lower risk for both lung cancer (aHR, 0.76 [95% CI, 0.64–0.90]) and chronic obstructive pulmonary disease (aHR, 0.81 [95% CI, 0.74–0.88]).

Conclusions:

The study authors concluded that: 1) switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking; 2) on CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs; and 3) when compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Perspective:

Nicotine is nicotine is nicotine (despite the packaging), but this important study suggests that switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. One could argue, from the findings of this study, that NNTPs may be an option in reducing the burden of nicotine dependence. More studies are needed to confirm the findings of this study in both men and women. Also, further studies are required to determine the impact of various types of NNTPs including nicotine vaping products (NVPs) and heated tobacco products (HTPs).

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Prevention, Smoking

Keywords: Cardiometabolic Risk Factors, Cardiotoxicity, Cardiovascular Diseases, Diagnostic Screening Programs, Electronic Nicotine Delivery Systems, Heart Disease Risk Factors, Lung Neoplasms, National Health Programs, Nicotine, Primary Prevention, Pulmonary Disease, Chronic Obstructive, Smokers, Smoking, Tobacco Products, Tobacco Smoking, Tobacco Use Disorder


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