title: Smokeless tobacco, sport and the heart.
abstract: Smokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation and could therefore promote premature atherogenesis. At rest, heart rate, blood pressure, inotropism, cardiac output and myocardial oxygen consumption are increased by nicotine, leading to an imbalance between myocardial oxygen demand and supply. The same occurs at submaximal levels of exercise. These increases are accompanied by a rise in systemic resistances. At maximal exercise, heart rate, cardiac output and maximal oxygen uptake (V˙O2max) are unaffected by nicotine. Because endothelial dysfunction is promoted by nicotine, paradoxical coronary vasoconstriction may occur during exercise and recovery. Nicotine induces a decrease in muscular strength and impairs anaerobic performance. However, nicotine is used in sports as it diminishes anxiety, enhances concentration and agility, improves aerobic performance and favours weight control. Importantly, smokeless tobacco, similar to cigarette smoking, leads to nicotine dependence through dopaminergic pathways. Smokeless tobacco has harmful cardiovascular effects and is addictive: it fulfils all the criteria for inclusion in the World Anti-Doping Agency prohibited list as a doping product. Smokeless tobacco use in sporting activities must be discouraged.
authors.affiliation: Cardiology Department, CHU de Dijon, Dijon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Chagué
authors.affiliation: Cardiology Department, CHU de Dijon, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Guenancia
authors.affiliation: Cardiology Department, CHU de Dijon, Dijon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gudjoncik
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Moreau
authors.affiliation: Cardiology Department, CHU de Dijon, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France. Electronic address: Marianne.zeller@u-bourgogne.fr.
authors.forename: Marianne
authors.initials: M
authors.lastname: Zeller
mesh_terms: D056352:Athletes; D054874:Athletic Performance; D002319:Cardiovascular System / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D004300:Doping in Sports; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008409:Mastication; D009538:Nicotine / Q000009:adverse effects* / Q000493:pharmacokinetics; D018722:Nicotinic Agonists / Q000009:adverse effects* / Q000493:pharmacokinetics; D058573:Performance-Enhancing Substances / Q000009:adverse effects* / Q000493:pharmacokinetics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D018722:Nicotinic Agonists; D058573:Performance-Enhancing Substances; D009538:Nicotine
keywords: Cardiovascular effects; Dopage; Doping; Effets cardiovasculaires; Nicotine; Smokeless tobacco; Sport; Sports; Tabac non fumé