Cigars & Pipes Increase Risk for Stroke, Other Adverse Outcomes

TOPLINE:

Smoking cigars was linked to an increased risk for stroke, atrial fibrillation, and heart failure, while smokeless tobacco raised the risk of dying from coronary heart disease. Pipe use showed associations primarily with developing heart failure.

METHODOLOGY:

• Researchers combined tobacco-related data with a pooled analysis from 15 United States–based cohorts spanning from 1948 to 2015.
• The analysis included 103,642 participants (mean age, 55.7 years; 47.8% women) who had used at least one noncigarette tobacco product including a pipe, cigar, or smokeless tobacco.
• Primary outcomes included myocardial infarction, stroke, heart failure, atrial fibrillation, all atherosclerotic cardiovascular disease (CVD) events, death from coronary heart disease and CVD, and all-cause mortality.
• Exclusive use was defined as current use of a noncigarette product, excluding people who currently or in the past smoked cigarettes; sole use included people currently using noncigarette tobacco, excluding current cigarette smokers.

TAKEAWAY:

• Current use of cigars was associated with an increased risk for stroke (hazard ratio [HR], 1.25; 95% CI, 1.01-1.55), atrial fibrillation (HR, 1.32; 95% CI, 1.13-1.53), and heart failure (HR, 1.29; 95% CI, 1.10-1.51), compared with people who never smoked cigars.
• People who exclusively smoked cigars had a 53% higher risk for stroke than those who never smoked cigars or cigarettes.
• Current pipe use was linked to a 23% increased risk for heart failure compared with individuals who never smoked pipes, while sole pipe use was associated with a 43% increased risk for myocardial infarction compared with those who never smoked pipes or cigarettes.
• Current smokeless tobacco use showed higher associations with coronary heart disease mortality (HR, 1.31; 95% CI, 1.08-1.59) and myocardial infarction (HR, 1.20; 95% CI, 1.03-1.39) than those who never used smokeless tobacco.
• Cigarettes increased the risk for cardiovascular and mortality outcomes the most over other products.

IN PRACTICE:

“Overall, these findings indicate more pronounced increases in risk and more consistent associations of combustible cigarettes across all nine outcomes, which is consistent with previous literature,” study authors wrote. “In contrast, associations of noncigarette tobacco products were more variable and had generally lower increases in risk.”

SOURCE:

The study was led by Michael J. Blaha, MD, MPH, of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. It was published online on January 13 in JAMA Network Open.

LIMITATIONS:

Other factors not included in the study may have influenced results. The study could not examine if using one of the products very rarely increased cardiovascular outcomes. Age, sex, race, and ethnicity were also not evaluated. The study only considered baseline tobacco use data, which may have changed during follow-up. Details about specific types of noncigarette tobacco products were unavailable.

DISCLOSURES:

Various authors reported receiving grants and personal fees from the National Institutes of Health, Amgen, the American Heart Association, and Novo Nordisk, among others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.