Introduction
Cigarette smoking is associated with an increased risk for peripheral artery disease.
It is unknown whether smokeless tobacco, a noncombustible form of tobacco exposure,
is also associated with increased peripheral artery disease risk. Using data from
the Atherosclerosis Risk in Communities study, we tested the hypothesis that the use
of smokeless tobacco is associated with a higher risk of developing peripheral artery
disease.
Methods
Participants with peripheral artery disease at baseline were excluded. Smokeless tobacco
use was assessed 3 times from 1987 to 1995, and peripheral artery disease events accrued
from 1987 to 2018. Smokeless tobacco was modeled as a time-dependent exposure in Cox
regression models. Analyses were completed in 2021.
Results
This study included 14,344 participants with a baseline mean (SD) age of 54.1 (5.7)
years; 54.8% were female, and 26.4% were Black. There were 635 incident peripheral
artery disease events over a median follow-up of 27.6 years (maximum of 32.1 years).
The peripheral artery disease incidence rate was 4.44 per 1,000 person-years among
those who used smokeless tobacco compared with 1.74 per 1,000 person-years for those
who did not. The hazard ratio for current versus never smokeless tobacco use was 1.94
(95% CI=1.31, 2.88) after adjustment for sociodemographic characteristics and cigarette
smoking. Peripheral artery disease incidence rate among those currently using smokeless
tobacco was similar to that of those who currently smoke cigarette (3.39 per 1,000
person-years).
Conclusions
Current smokeless tobacco use was associated with high rates of peripheral artery
disease, similar to cigarette smoking. Future research should evaluate the effect
of cessation of noncombustible tobacco on incident peripheral artery disease.
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REFERENCES
- Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.Lancet. 2013; 382: 1329-1340https://doi.org/10.1016/S0140-6736(13)61249-0
- Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.Circulation. 2009; 120: 2053-2061https://doi.org/10.1161/CIRCULATIONAHA.109.865600
- Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases.J Am Coll Cardiol. 2019; 74: 498-507https://doi.org/10.1016/j.jacc.2019.05.049
- Consumption of combustible and smokeless tobacco — United States, 2000–2015.MMWR Morb Mortal Wkly Rep. 2016; 65: 1357-1363https://doi.org/10.15585/mmwr.mm6548a1
- Tobacco product use among adults — United States, 2019.MMWR Morb Mortal Wkly Rep. 2020; 69: 1736-1742https://doi.org/10.15585/mmwr.mm6946a4
- Smokeless tobacco and cardiovascular risk.Arch Intern Med. 2004; 164: 1845-1849https://doi.org/10.1001/archinte.164.17.1845
- Risk of incident cardiovascular disease among users of smokeless tobacco in the atherosclerosis risk in communities (ARIC) study.Am J Epidemiol. 2010; 172: 600-605https://doi.org/10.1093/aje/kwq191
- Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States).Cancer Causes Control. 2005; 16: 347-358https://doi.org/10.1007/s10552-004-5519-6
- The ARIC (atherosclerosis risk in communities) study: JACC focus Seminar 3/8.J Am Coll Cardiol. 2021; 77: 2939-2959https://doi.org/10.1016/j.jacc.2021.04.035
- Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association.Circulation. 2010; 122: 1520-1544https://doi.org/10.1161/CIR.0b013e3181f432c3
- Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis.Eur J Prev Cardiol. 2016; 23: 1970-1981https://doi.org/10.1177/2047487316654026
FDA permits marketing of E-cigarette products, marking first authorization of its kind by the agency. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-e-cigarette-products-marking-first-authorization-its-kind-agency. Updated December 12, 2021. Accessed September 27, 2022.
FDA denies authorization to market JUUL products. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products. Updated June 23, 2022. Accessed September 27, 2022.
- Can e-cigarettes help adults who smoke successfully quit all combusted tobacco products?.JAMA Netw Open. 2021; 4e2130924https://doi.org/10.1001/jamanetworkopen.2021.30924
- Validation of self-reported smokeless tobacco use by measurement of serum cotinine concentration among U.S. adults.Am J Epidemiol. 2014; 180: 749-754https://doi.org/10.1093/aje/kwu182
Article info
Publication history
Published online: January 21, 2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
