New Study Links Non-Cigarette Tobacco Use to Heart Disease

The Overlooked Risks of Non-Cigarette Tobacco

While cigarette smoking has long been established as a major cause of heart disease, a groundbreaking study reveals that cigars, pipes and smokeless tobacco are far from harmless. These alternative tobacco products, often marketed as safer choices, have now been linked to increased risks of cardiovascular disease (CVD) and death, prompting calls for stricter regulations and greater public awareness.

Extensive Study Unveils Surprising Findings

Researchers from the Cross Cohort Collaboration Tobacco Working Group (CCC-Tobacco) analyzed long-term data from 15 U.S. cohort studies involving 322,782 individuals. Spanning several decades (1948-2015), the study examined the cardiovascular impact of non-cigarette tobacco use, including cigars, pipes and smokeless tobacco, compared to never-users and cigarette smokers.

Among the 103,642 participants assessed, the study found:

·         Cigar smokers had a significantly higher likelihood of suffering a stroke (HR: 1.25), atrial fibrillation (HR: 1.32), and heart failure (HR: 1.29).

·         Pipe smokers faced a 23% higher risk of heart failure compared to non-smokers.

·         Smokeless tobacco users saw an increase in CHD mortality (HR: 1.31), CVD mortality (HR: 1.23), and heart attack risk (HR: 1.20).

The Growing Use of Alternative Tobacco Products

Despite the decline in traditional cigarette smoking, the use of cigars, pipes and smokeless tobacco has remained steady or even increased. From 2016 to 2020, cigarillo unit sales rose from 131 million to 190 million, averaging a 0.7% monthly increase in the U.S. alone.

Tobacco companies have strategically marketed these products as ‘safer alternatives’ or as part of a luxury lifestyle. Additionally, flavored cigars and smokeless tobacco products, which remain legally available despite bans on flavored cigarettes are particularly appealing to young users.

Why These Findings Matter

The study challenges the misconception that cigars, pipes and smokeless tobacco are safer alternatives to cigarettes. Health experts warn that these products carry serious health risks, yet they often escape the same level of regulation and taxation as cigarettes.

With the FDA’s regulatory scope expanding, researchers argue that these findings should push for stronger policies to curb non-cigarette tobacco use. In particular, the marketing of flavored cigars and single-stick sales—which are known to attract younger demographics—should be reevaluated and restricted to prevent a new generation of tobacco-related illnesses.

The Future of Tobacco Control

While this study provides strong evidence linking non-cigarette tobacco use to heart disease, further research is needed to analyze the long-term effects of newer tobacco products, including e-cigarettes.

Public health officials emphasize that education and awareness campaigns should target all forms of tobacco use, not just cigarettes. Many consumers remain unaware that cigars contain higher concentrations of nicotine and toxins, making them just as, if not more, harmful than cigarettes when inhaled. Similarly, smokeless tobacco products can lead to oral cancers, high blood pressure and cardiovascular strain.

The Call for Stricter Regulations

Given these findings, experts suggest the following measures:

• Higher taxation on cigars and smokeless tobacco, similar to cigarette taxes.

• Increased labeling and health warnings on all non-cigarette tobacco products.

• More aggressive public education campaigns to highlight the risks.

• A ban on flavored cigars and single-stick sales to reduce youth appeal.

Key Insights:

This large-scale analysis makes it clear: non-cigarette tobacco products are not risk-free. As cardiovascular disease remains a leading cause of death worldwide, reducing tobacco-related harm requires action beyond just cigarette smoking.

Stricter regulations, public health initiatives, and continued research will be key in protecting consumers from the often-overlooked dangers of cigars, pipes, and smokeless tobacco. With the right policies and awareness, the hope is to curb tobacco-related illness and promote healthier alternatives for future generations.

By - Eeshan Aggarwal

Reference:

Tasdighi E, Yao Z, Jha KK, Dardari ZA, Osuji N, Rajan T, Boakye E, Rodriguez CJ, Matsushita K, Simonsick EM, Lima JA. Cigar, pipe, and smokeless tobacco use and cardiovascular outcomes from Cross Cohort Collaboration. JAMA Network Open. 2025 Jan 2;8(1):e2453987-.