Smokeless Tobacco Causes Heart Disease and Death

Aug. 17, 2010 - PRLog -- Despite claims that smokeless tobacco and other nicotine administration products such as e-cigarettes [e-cigs] virtually eliminate the risks causes by smoking conventional tobacco cigarettes, a new study shows that smokers who switch from cigarettes to one of these substitutes still have a much higher risk of death than someone who gave up nicotine entirely, says Professor John Banzhaf, Executive Director of Action on Smoking and Health (ASH).

The new study, due to be published in the American Journal of Epidemiology, concludes that "current use of smokeless tobacco at baseline was associated with 1.27-fold greater incidence of cardiovascular disease . . .  than was nonuse, independently of demographic, socioeconomic, and lifestyle and other tobacco-related variables."  http://aje.oxfordjournals.org/cgi/content/abstract/kwq191

The authors conclude that: "current users of smokeless tobacco should be informed of its harm and advised to quit the practice. Current cigarette smokers should also be given sufficient information on safe, therapeutic methods of quitting which do not include switching to smokeless tobacco."

This is very important, says Banzhaf, because many people think that eliminating the cancer-causing chemicals in tobacco smoke will slash their health risk, and thus may think switching is a viable alternative to quitting entirely.  But cigarettes kill more smokers each year from heart attacks than from lung cancer, so even a total elimination of the cancer risk would still leave the major cause of death.  This study confirms that the risk of switching rather than quitting remains a major one.

From a broader perspective, another recent study shows that, even if replacing tobacco cigarettes with nicotine administration products like e-cigs or snus significantly reduces the individual user's risk of death, a public health strategy based upon promoting such products may save few if any lives, and may even raise the death rate in the total population.  The study shows that, even if switching to an alternative source of nicotine reduces the individual user's risk of death, more people overall may die and public health may suffer because of two different types of population effects. http://tobaccocontrol.bmj.com/content/19/4/297.abstract

First, some smokers who would otherwise be persuaded to quit - give up all nicotine use - by smoking bans and/or high taxes will instead switch to the substitute, thereby remaining at a much higher risk than if they had quit entirely.  "If lots of smokers who would otherwise quit instead switch to e-cigs, public health will suffer, since the risks of using e-cigs can be considerable," notes Banzhaf.

For example, another major study showed an association between the use of chewing tobacco (which administers nicotine) and acute myocardial infarction that was 75% of the risk of smoking cigarettes. The Food and Drug Administration [FDA] has just warned that e-cigarettes pose "acute health risks," and that the "danger posed by the unrestricted distribution of [these] unregulated products containing toxic chemicals cannot seriously be questioned."

Even more serious, other smokers who might otherwise be pressured to quit by bans on smoking in the workplace may be able to remain smokers by using nicotine administration products while at work - a use for which they are prominently advertised.  In such situations they not only fail to get the health benefit of quitting entirely, but also wind up as "dual users" with the combined risks of both smoking tobacco cigarettes and of the nicotine substitute product. Thus their overall health risk might simply be additive (the sum of the risks of both products) or, as some have suggested, synergistic (higher than the sum of the risks of both products).

Second, some children and others who might otherwise avoid all tobacco or nicotine use will instead: (1) take up the substitute with all of its known and unknowable health risks; or (2) become addicted to nicotine in the substitute and ultimately graduate from e-cigs or snus to simply smoking; or, worse, (3) continue using e-cigs or snus but yield to the nicotine addiction and eventually also take up smoking in addition, thereby becoming dual users with dual risks.

In all such cases the overall national health risk and death rate would be much higher because of the ready availability of e-cigs, snus, or other similar nicotine-administration products. Any of these scenarios increases the death rate over what it would have been if the nicotine product were simply not available.

Banzhaf, who is a noted mathematician and the inventor of the Banzhaf Index, reminds everyone that different outcomes can be predicted by making various different estimates as to the relative risks of tobacco cigarettes and e-cigs, the percentage of people who would quit if e-cigs were not available, the percentage who would switch if e-cigs are widely promoted, etc.  But that's why a recent study is so important, he maintains.

The study actually tries to make the best estimates of the variables which must be considered; estimates based upon currently available evidence. After a careful analysis, the study concludes that overall cumulative public health risk would increase by about 25% if nicotine-administration products were widely promoted. The study focused on oral tobacco such as snus, but seems equally applicable also to other forms of harm-reduction nicotine-administration products such as e-cigs.

In summary, promoting nicotine-administration alternatives such as snus or e-cigs may be unwise from an overall public health point of view, even if the products are a less hazardous alternative than smoking conventional cigarettes. ASH has not taken a position on this scientific and medical issue, noting that the FDA is studying this difficult and important question with the support of many learned scientists and other experts.

ASH also has not opposed the sale and use of e-cigs by adults. What ASH has opposed is the sale of new nicotine products without any FDA testing to assure safety, efficacy, and ingredient purity, limits on sales to children, protections against unfounded claims made by promoters, and their use in public places where others are forced to inhale e-cig vapors which contain nicotine (a deadly and addictive drug which can contribute to heart attacks and cancer) and propylene glycol (a respiratory irritant used in antifreeze and known to cause respiratory tract infections).

PROFESSOR JOHN F. BANZHAF III
Professor of Public Interest Law at GWU,
FAMRI Dr. William Cahan Distinguished Professor,
FELLOW, World Technology Network, and
Executive Director and Chief Counsel
Action on Smoking and Health (ASH)
America’s First Antismoking Organization
2013 H Street, NW
Washington, DC 20006, USA
(202) 659-4310 // (703) 527-8418
Internet: http://ash.org/
Twitter: http://twitter.com/AshOrg

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Action on Smoking and Health (ASH), America's first anti-smoking and nonsmokers' rights organization, serves as the legal action arm of the anti-smoking community. It is supported by tax-deductible contributions.