title: Effects of smokeless tobacco "Maras powder" use on nitric oxide and cardiovascular risk parameters.
abstract: BACKGROUND
  Smokeless tobacco use is common in various parts of the world. In Turkey a type of smokeless tobacco called "Maras powder" is widely used in southeastern region. Smoking is known to have an adverse effect on nitric oxide and cardiovascular risk factors. The aim of this study was to evaluate whether there is difference between the effects of Maras powder and cigarette smoking on the cardiovascular risk factors and nitric oxide levels.
  
  
  METHODS
  In the study, participants were 48 Maras powder users, 50 cigarette smokers and 45 nontobacco user subjects. Blood samples were collected and hematological parameters and lipid parameters were measured. Plasma Nitric oxide level was also detected by using the Griess method.
  
  
  RESULTS
  Plasma total cholesterol, LDL-cholesterol, triglyceride levels were significantly higher in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Plasma HDL-cholesterol levels were significantly lower in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Plasma Nitric oxide levels were found significantly lower in Maras powder and cigarette smokers group compared to the nontobacco user group (4.9±0.9 µmol/l, 4.8±1 µmol/l, 9.4±3.4 µmol/l, respectively, p<0.001) whereas there was no significant difference between the Maras powder and cigarette smokers group. In multivariate logistic regression model, cigarette smoking (Odds ratio=17.832, p<0.001), Maras powder usage (Odds ratio=12.311, p=0.002) and mean platelet volume (Odds ratio=1.425, p=0.030) remained independently associated with lower Nitric oxide levels.
  
  
  CONCLUSIONS
  We conclude that Maras powder has similar adverse effects on nitric oxide level and cardiovascular risk parameters and thereby it appears to be harmful as cigarette smoking.
authors.affiliation: Baskent University School of Medicine, Department of Cardiology, Konya, Turkey.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Guven
authors.forename: Fatma
authors.initials: F
authors.lastname: Tolun
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009569:Nitric Oxide / Q000097:blood*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000097:blood*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D009569:Nitric Oxide; D002784:Cholesterol
keywords: Maras powder; cigarette.; nitric oxide; smokeless tobacco