title: Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players.
abstract: BACKGROUND
  The use of smokeless tobacco (ST), which has increased in popularity over the past 2 decades, results in considerable systemic exposure to nicotine. Nicotine might contribute to atherosclerosis by an effect on cardiovascular risk factors.
  
  
  METHODS
  The effects of ST use on cardiovascular risk factors and cotinine and nicotine levels were studied in 1061 professional baseball players during spring training in 1988 and 1989.
  
  
  RESULTS
  Of the study participants 477 (45%) were users. ST use was more common among Whites (55%) than among Blacks (29%) or Hispanics (21%), and users reported heavier consumption of alcohol (p less than .001) and had higher mean serum caffeine levels (p less than .001) than nonusers. ST users did not differ from nonusers in adjusted levels of systolic and diastolic blood pressure, pulse, and total or HDL-cholesterol. Among ST users, participants using snuff had higher mean serum cotinine levels than those who used chewing tobacco (p less than .001). There was no association between serum cotinine levels and adjusted levels of any cardiovascular risk factor studied. However, higher diastolic blood pressures were associated with higher mean serum nicotine levels (p = .02).
  
  
  CONCLUSIONS
  Smokeless tobacco use has at most a modest effect on cardiovascular risk factors in young physically fit men.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco.
authors.forename: D
authors.initials: D
authors.lastname: Siegel
authors.forename: N
authors.initials: N
authors.lastname: Benowitz
authors.forename: V L
authors.initials: VL
authors.lastname: Ernster
authors.forename: D G
authors.initials: DG
authors.lastname: Grady
authors.forename: W W
authors.initials: WW
authors.lastname: Hauck
mesh_terms: D000328:Adult; D001741:Black or African American; D000428:Alcohol Drinking / Q000453:epidemiology; D001130:Arizona / Q000453:epidemiology; D001484:Baseball; D002110:Caffeine / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003367:Cotinine / Q000097:blood*; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007958:Leukocyte Count; D009538:Nicotine / Q000097:blood*; D009790:Occupations; D010947:Plants, Toxic; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D044465:White People
chemical_list: D008076:Cholesterol, HDL; D002110:Caffeine; D009538:Nicotine; D002784:Cholesterol; D003367:Cotinine