title: Smokeless tobacco and cardiovascular disease in low and middle income countries.
abstract: Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06-1.21) and fatal stroke of 1.40 (1.28-1.54) while in Asian countries it was 1.26 (1.12-1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41-3.52), which was lower than smokers (2.89, 2.11-3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98-5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction.
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, JLN Marg, Jaipur 302017, India. Electronic address: rajeevg@satyam.net.in.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.forename: Nishant
authors.initials: N
authors.lastname: Gupta
authors.forename: R S
authors.initials: RS
authors.lastname: Khedar
mesh_terms: D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000150:complications* / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
keywords: Cardiovascular disease; Smokeless tobacco; Smoking: coronary heart disease; Tobacco