AHA: Don’t Be Fooled, Smokeless Tobacco Isn’t Exactly Safe

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If you think chewing on tobacco is any better for your health than smoking it, the American Heart Association (AHA) respectfully disagrees. The national nonprofit group released a statement Monday discouraging smokers from relying on smokeless tobacco as an alternative to cigarettes or as a stop-smoking aid.

In a report that summarizes the latest data on the health effects of smokeless tobacco, which includes chewing tobacco, snuff, lozenges, tobacco strips (these look and work like mouthwash strips that dissolve in the mouth) and something called snus, a drier and supposedly “cleaner” form of moist snuff that is popular is Sweden, scientists found that smokeless products can increase risk of heart attack and stroke.

Only a handful of studies have analyzed the heart effects of smokeless tobacco, and the findings are not as strong as the researchers expected. The studies did not find, for example, that smoke-free tobacco products were strongly correlated with high blood pressure, a risk factor for heart disease. But in the few studies that measured heart attack and stroke rates, smokeless tobacco users did show higher risks of 30% and 40% of these conditions, respectively, compared with those who did not.

In the U.S., about 8 million people get their nicotine this way, some of them believing that they are doing their bodies a favor by avoiding cigarettes and cigars. To a certain extent, they’re right; overall, users of smokeless tobacco have a lower risk of heart problems than those who smoke, but smokeless tobacco users are at greater risk of developing certain cancers of the mouth and throat that comes from absorbing tobacco carcinogens via the mucosa.

And smokeless products contain the same chemical compounds, including nicotine, that have been linked to heart disease in cigarettes. Many of these are oxidants that generate the free radicals that promote inflammation and blood clots that stiffen heart arteries.

That’s why the AHA is taking the position that no form of nicotine-containing tobacco is safe. While shifting from cigarettes to smokeless products may lessen heart risk, it’s not an effective way to stop smoking. In the only study analyzing smokeless tobacco’s role in helping smokers to quit, 36% of those switching from cigarettes to a smokeless product and participating in group therapy remained abstinent from smoking after three months, compared with 21% of those relying just on the counseling; but after six months, the benefit had disappeared.

The same same trend held in Sweden, when health officials noted a decline in smoking among men from 40% to 15% between 1976 and 2002, primarily due to the uptake of snus, which doubled in the same time period. More recent data, however, found no association between smoking cessation and snus use.

In the U.S., the AHA notes that since the government enforced stricter bans on smoking in public places and passed the Tobacco Control Act in 2009, which gives agencies such as the Food and Drug Administration the authority to regulate the sale of tobacco products, tobacco manufacturers have marketed smokeless tobacco as an alternative to cigarettes. “Many people who can’t smoke cigarettes use smokeless tobacco instead, or become dual users,” says Dr. Neal Benowitz, professor of medicine at University of California San Francisco and a co-author of the policy statement. “That’s a huge concern. And there is also the concern about the addictiveness of the smokeless products compared to nicotine medications.” Some studies, in fact, found that users moved from smokeless tobacco products to become smokers.

Taken together, says Benowitz, these risks were enough to prompt the AHA to advise against depending on smokeless tobacco products either as an alternative to smoking or as a way to quit smoking. “We can’t say smokeless tobacco is safe from a cardiovascular point of view,” he says.