Cigars, Pipes, and Smokeless Tobacco: More Harm to the Heart Than Expected, Study Finds

"Current cigar use was associated with a 25% higher risk of stroke, a 32% higher risk of atrial fibrillation, and a 29% higher risk of heart failure. Pipe use was linked to a 23% increased risk of heart failure and a 43% higher risk of myocardial infarction (MI). Smokeless tobacco users faced a 20% higher risk of MI and a 31% higher risk of mortality from coronary heart disease, along with elevated risks for total cardiovascular disease, heart failure, and all-cause mortality," the researchers reported.

The cardiovascular health impacts of noncigarette tobacco products, such as cigars, pipes, and smokeless tobacco, are not well understood, yet this information is crucial for informed regulatory decisions. Erfan Tasdighi, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, and colleagues aimed to explore the relationship between noncigarette tobacco use and cardiovascular health outcomes.

For this purpose, the researchers conducted a cohort study as part of the Cross Cohort Collaboration Tobacco Working Group. The study harmonized tobacco-related data from 15 US-based prospective cohorts, spanning data on noncigarette tobacco use between 1948 and 2015. The analysis was performed between September 2023 and February 2024, with a median follow-up of 13.8 years for all-cause mortality outcomes.

The study focused on the current, sole, and exclusive use of noncigarette tobacco products. Sole use refers to individuals using a noncigarette tobacco product without cigarette smoking, while exclusive use means using only noncigarette tobacco and never having smoked cigarettes.

The main outcomes and measures included myocardial infarction, stroke, heart failure, atrial fibrillation, total coronary heart disease, total cardiovascular disease (CVD), coronary heart disease mortality, CVD mortality, and all-cause mortality.

The following were the key findings of the study:

• The study included 103,642 participants with an average age of 55.7 years, of which 47.8% were female and 52.2% were male.
• Current use rates were 26.3% for cigarettes, 2.1% for cigars, 1.2% for pipes, and 2.1% for smokeless tobacco.
• Current cigar use was linked to a higher risk of stroke, atrial fibrillation, and heart failure.
• Sole and exclusive cigar use was associated with an even higher risk of stroke compared to those who never used cigars or cigarettes.
• Current pipe use was connected to a higher risk of heart failure, while sole pipe use was linked to a higher risk of myocardial infarction (MI).
• Smokeless tobacco use was linked to an increased risk of coronary heart disease mortality and myocardial infarction.
• Sole and exclusive smokeless tobacco use was associated with higher risks for total cardiovascular disease (CVD), coronary heart disease, heart failure, and both cardiovascular and all-cause mortality.

"This large multicohort study is the most extensive to date on the link between cigars, pipes, smokeless tobacco, and combustible cigarettes with cardiovascular disease. Our findings suggest that using noncigarette tobacco products can cause significant harm, especially to heart health. However, the risks varied across different products, with pipes showing the smallest increase in risk," the researchers wrote.

"The insights from this study may help guide regulations on new tobacco products and set the stage for future research on emerging tobacco products," they concluded.

Reference:

Tasdighi E, Yao Z, Jha KK, et al. Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration. JAMA Netw Open. 2025;8(1):e2453987. doi:10.1001/jamanetworkopen.2024.53987