How harmful is snuff smokeless tobacco?

The major multinational cigarette manufacturers have begun to produce and market smokeless tobacco products (partly by buying smokeless tobacco companies). As the price of cigarettes increases and smoke-free air laws make it impossible to smoke in public places, more and more smokers are considering the option of switching to smokeless tobacco. So what are the health risks from smokeless tobacco and how do they compare to smoking?

I’ve previously written on this issue, and the summary version goes like this:
- different types of smokeless tobacco (chew, moist snuff, dry snuff, snus, etc) may have different risks
- unlike cigarettes, none of the smokeless tobaccos cause lung cancer or respiratory diseases
- smokeless tobaccos contain carcinogens and may increase the risks of oral and pancreatic cancer (but less than cigarettes)
- smokeless tobacco can cause oral lesions and gum disease
- the nicotine in smokeless tobacco can be harmful to the unborn baby during pregnancy

But last week a new study was published on the cardiovascular risks from smokeless tobacco. This study combined the results from a number of other large studies in order to provide a more accurate estimate of risk. The study, by Drs Boffetta and Straif at the International Agency for Research on Cancer, found that while long- term use of smokeless tobacco does not increase risks of having a heart attack, it does increase the risks of having a fatal heart attack (by about 13%) or a fatal stroke (by about 40%).

The idea that smokeless tobacco increases risks of a fatal cardiovascular event is plausible because nicotine is known to influence the cardiovascular system (e.g. causing an acute increase in heart rate and blood pressure and constriction of peripheral blood vessels). Why it would increase risks of a fatal heart attack without increasing the risk of having a heart attack is a bit harder to explain.

Overall, it is clear that smokeless tobacco is far from harmless. On the other hand, it is equally clear that smokeless tobacco is much less harmful to health than cigarettes. Even the risks for all of these illnesses are lower from smokeless than from smoking. And the major respiratory risks from smoking (lung cancer, COPD etc) don’t apply to smokeless tobacco at all. This has led expert groups to estimate that smokeless tobacco is at least 90% less harmful than smoking.

Of course, for the smoker the key to improved health is completely quitting smoking. It won’t do any good at all to use smokeless tobacco in places you can’t smoke, only to pick up your cigarettes where that is allowed. Far better to quit tobacco altogether.

The new study on cardiovascular risks of smokeless tobacco can be found at:
http://www.bmj.com/cgi/content/full/339/aug18_2/b3060

Chapter 8 of the recent Royal College of Physicians report on “Harm Reduction in Nicotine Addiction” provides a review of the overall health risks from smokeless tobacco and can be found at:
http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=234

Labels: cancer, cardiovascular risks, jonathan foulds, smokeless tobacco, snuff

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