Re: Smokeless and heart disease

General

Smokeless and heart disease

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Anonymous 08-20-2006, 7:58 AM
What do you have to say about the recently reported study by Canadian researchers linking all forms of tobacco use to heart disease? Thank you for your answer.

A short quote from a news article about the study:
"The findings come from data from more than 27,000 people in 52 countries. Koon K. Teo, MB, PhD, of the University of Hamilton, Ontario, Canada, and colleagues combed through the data for evidence that tobacco use changed your risk for heart attack.

"Tobacco use is one of the most important causes of [heart attack] globally, especially in men," Teo and colleagues conclude. "All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of second-hand smoke, should be discouraged."

Re: Smokeless and heart disease

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Carl V. Phillips 08-29-2006, 2:52 PM
There are some things that are very odd about that study's results and how they were interpreted and presented, and several of us are trying to figure them out now.  (It is not widely understood, but interpreting health science data is not a quick or simple process, and it is often not wise to just accept the authors' stated interpretation, let alone the simplified information in the press release that appears in the popular press.)  I will try to post more about this here when we make some progress with that.

There are a few quick responses that can be offered:  The results of one study should never be interpreted as replacing previous knowledge.  It has always been plausible that nicotine use in any form (including smokeless tobacco) causes some small risk for cardiovascular disease, as we note in the FAQ, but the point estimate presented in the research report you cite is implausibly high based on what we already knew.  This is not the only result in that report that contradicts substantial previous evidence.  The study results are presented in ways that make them extremely difficult to interpret (which is is contrary to what we should expect from scientific publishing, though unfortunately not terribly unusual in health science journals), so it is unclear what the reported statistics actually mean.

In short, until this result is critically reviewed, we should hesitate to make much of it, but in any case it does not change the basic knowledge that we already had:  There might be some CVD risk from smokeless tobacco -- some studies suggest there is no measurable risk, while others suggest there is measurable risk -- but any such risk is clearly much lower than the risk from smoking.

Carl Phillips

Re: Smokeless and heart disease

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Anonymous 10-29-2006, 8:04 AM

"Do NO harm!" should be every physician's, health care provider's, public health advocate's montra!

As you say, if research is suggesting that smokeless tobacco use is causing measurable risk and use-related illness, then it should not be considered as a treatment. This is especially true when there are research proven, known effective, non-nicotine, pharmaceutical treatments choices available!   

Re: Smokeless and heart disease

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admin 11-01-2006, 10:16 AM
No harm at all is certainly preferable.  But consider the many lives already saved by the use of seatbelts and airbags.  Both of these safety devices have an associated small "measurable risk" but their life saving benefits hugely outweigh the risk.  In terms of risk reduction it would be best if people didn't drive at all.  Like smoking, some people do give up driving but many don't or can't.  Just because there is the better option of not driving, and therefore a safer alternative, is no reason to remove these safety devices.  A little bit of harm such as a bruised rib from an airbag going off is much better than dying.  As to using pharmaceutical nicotine, see our FAQ for reasons why that just doesn't work for everyone.  Its all about providing as many harm reducing options as possible.