The use of noncigarette tobacco products is associated with considerable cardiovascular risk, as demonstrated by relevant inflammation, thrombosis and atherosclerosis markers, according to a cross-sectional study published Jan. 27 in Circulation.

Zhiqi Yao, MD, ScM, et al., used tobacco-related data combined with subclinical markers related to cardiovascular harm from prospective cohorts within the Cross-Cohort Collaboration-Tobacco (CCC-Tobacco) Working Group for the current study. The researchers evaluated use of both cigarettes and noncigarette tobacco products, including cigar, pipe and smokeless tobacco, and their relationship with markers of inflammation, thrombosis and subclinical atherosclerosis. Markers included high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), fibrinogen, D-dimer, coronary artery calcium, carotid intima-media thickness (cIMT), carotid plaque and ankle-brachial index.

The current study included 98,450 participants, spanning >50 years (1958-2011), from the CCC-Tobacco data set. Specifically, 20.0%, 3.0%, 0.8% and 1.5% of individuals were current cigarette, cigar, pipe or smokeless tobacco users, respectively. The authors analyzed current use status for each product, as well as sole and exclusive noncigarette use. Sole use was defined as noncigarette tobacco combined with concurrent cigarette use, whereas exclusive use was defined as noncigarette tobacco and no history of cigarette use.

Results showed that cigarette use was associated with higher levels of all eight cardiovascular subclinical markers compared with never cigarette use. Furthermore, current, sole and exclusive cigar use was associated with 10% (95% CI, 1-20), 19% (95% CI, 12-26), and 11% (95% CI, 2-21) higher hs-CRP on the geometric mean scale. Pipe and smokeless tobacco use showed similar associations. Regarding IL-6, sole cigar use had a 15% (95% CI, 6-24) higher geometric mean level, while current, sole and exclusive pipe use were associated with 22% to 32% higher levels compared with their respective reference groups (p<0.05 for all). Fibrinogen levels were 2% to 6% higher among current cigar, pipe and smokeless tobacco users as well (p<0.05 for all). Carotid plaque and cIMT were also moderately associated with noncigarette tobacco use.

The authors note that "sensitive subclinical markers, such as hs-CRP and IL-6, could be valuable in regulatory science to assess the harmful health effects of short-term noncigarette tobacco use before clinical cardiovascular disease is apparent, given their consistently elevated levels among users of these products."