Impact of smokeless tobacco products on myocardial infarction and stroke and it’s prognostic significance

Abstract

Background: The use of smokeless tobacco (SLT) predates smoking and its effects on the health of the individuals is very much similar tobacco smoking. The present study was done with the aim to find out independent prognostic significance of ST products on disease outcome like myocardial infarction and stroke.Methods: This prospective study was done on the patients attending to the Department of Internal Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar with complaints suggesting of coronary artery disease and stroke during the period from July 2016 to June 2018. The exposure of risk factors and confounding factors are detailed and collected from the patients by using predesigned questionnaire. All the data was analysed by using SPSS version 20.Results: During the study period a total of 423 patients were included in the study. Mean average age of the participants was 56.58±11.23 years. Male preponderance was seen in the study. Out of total patients, myocardial infarction was noticed in 49 and stroke in 64 patients. SLT was used by 323 (76.4%) users. Among SLT both gutkha and pan was most commonly used (55.6%). Among them hypertension and diabetes were seen in 193 and 184 patients respectively. Risk of incidence of CVA and stroke was found to be more among SLT users compared to non-users.Conclusions: SLT is considered to be an important etiological factor for the incidence of myocardial infarction and stroke. There is an urgent need to increase clinical interventions and awareness in public to decrease SLT addiction.

The health impact of smokeless tobacco products: a systematic review

“…A poor-rated meta-analysis reported an association between SLT-products and stroke in SE Asia (OR = 1.35; 95% CI 1.18–1.51), but not in Mediterranean [ 11 ]. A poor-rated cohort study in India reported increased stroke (OR = 3.71; 95% CI 1.57–9.05) and myocardial infarction (MI) (OR = 2.34; 95% CI 1.10–5.40) in SLT users without excluding former smokers [ 17 ].…”

“…Four meta-analyses, three global, including 14 [ 11 ], 20 [ 10 ] and 19 global [ 12 ] studies, and one of 24 EU studies [ 47 ], of which three were rated as ‘good’ [ 10 , 12 , 47 ], and all of mixed study-designs, found no association between snus use and IHD (RR = 1.04; 95% CI 0.93–1.16) [ 47 ], (OR = 0.91; 95% CI 0.83–1.01) [ 12 ], CHD (OR = 0.93; 95% CI 0.81–1.06) [ 17 ], or stroke (OR = 1.04, 95% CI 0.94–1.15) [ 11 ], (RR = 1.04; 95% CI 0.92–1.17) [ 47 ], (OR = 1.01; 95% CI 0.90–1.13) [ 19 ] in studies that excluded former smokers.…”

The Health Impact of Smokeless Tobacco Products: A Systematic Review

“…A meta-analysis on SLT products and stroke which did not account for heterogeneity and variation in handling of smoking status between studies reported an association between SLT products and stroke globally (OR=1.18; 95% CI: A poor-rated cohort study in India found an association between SLT products and stroke (OR=3.71; 95% CI: 1.57-9.05) and myocardial infarction (MI) (OR=2.34; 95% CI: 1.10-5.40) but had not excluded former smokers. 24 A cross-sectional study in India showed no association between SLT product use and diabetes or hypertension in exclusive SLT product users, 25 although former smoking was not accounted for. One small cross-sectional study of 36 individuals with mental and behavioral disorders in India showed no association with CHD compared with exclusive smokers, 26 and another with 30 exclusive SLT product users showed strong associations with dyslipidaemia (OR=6.37; 95% CI: 1.4-27.3) and hypertension (OR=6.97; 95% CI: 1.7-28.0) compared to non-tobacco users.…”