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The data on the health effects from smoking cigarettes has been clear for decades. Today, tobacco use causes nearly 1 in 5 deaths each year in the U.S. While many of these deaths are cancer-related, researchers have found that people who smoke are more likely to die from heart disease than lung cancer.
In late 2024, a U.S. Surgeon General’s report on tobacco use addressed challenges that have contributed to another generation being addicted to nicotine, including flavored products, and predatory marketing practices.
But cigarettes are not the only culprit.
While cigarette smoking rates have plummeted from nearly 50% of adults in the 1960s to just under 12% in 2022, people use other tobacco products at about the same rate as they always have. While graphic new warning labels will soon help remind people of the dangers of cigarettes, no such labels are required for non-cigarette products.
Data from the Centers for Disease Control and Prevention in 2021 estimates that among U.S. adults:
3.5% smoked cigars
0.9% report pipe and/or hookah use
2.1% used smokeless tobacco products such as snuff or dip
One reason why may be that the health effects of these non-cigarette tobacco products are less clear. Fewer people use these products, so it’s been difficult to conduct a large-scale scientific study of their impacts. It has also been challenging for national and international authorities to regulate these products given their unclear impact on health risks.
However, by analyzing data from several smaller studies that recorded tobacco product use and their outcomes, answers about the cardiovascular effects of specific non-cigarette tobacco products are becoming clearer.
Looking at health effects from different tobacco products
UT Southwestern participated in an observational study led by researchers with the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease that was published in JAMA Network Open. The findings suggest that pipes, cigars, and smokeless tobacco products are associated with specific and significant risks to cardiovascular health.
Patients and health care providers should discuss the use of these products and make a plan to quit. Regulators, meanwhile, should take note of the significant health risks now clearly associated with these products.
How bringing data together yields new insight
The consortium assembled tobacco-related data from 15 different studies in the U.S. from 1948 to 2015. One of these was UTSW’s landmark Dallas Heart Study, the only single-center heart study of its size and multiethnic composition, which includes data from 6,000 Dallas County residents.
Altogether, data from 103,642 patients were studied. The average age of patients was 55.7 years old, and they were divided nearly evenly between females (48%) and males (52%).
Researchers standardized the data from these different studies to gather enough information on non-cigarette tobacco product use to draw statistically meaningful conclusions about specific cardiovascular outcomes.
How tobacco products affect cardiovascular health
When it comes to the health of your heart and blood vessels, tobacco products can cause major problems. When you smoke or dip, nicotine and other harmful chemicals enter your bloodstream where they begin to cause damage and inflammation. This damage can lead to the development of atherosclerosis, when plaque builds up inside your arteries.
Carbon monoxide from smoking decreases the amount of oxygen your red blood cells can carry throughout the body and leads to more cholesterol deposited in the arteries.
Nicotine, the highly addictive substance found in most tobacco products and in many e-cigarettes, can cause several cardiovascular problems, including hardening and narrowing of arteries, increased blood pressure, and increased heart rate.
After standardizing data from the cohort of studies, the authors identified an increased risk of specific heart and blood vessel conditions associated with each type of tobacco product: Use of cigars increased the risk of stroke, atrial fibrillation, and heart failure. Smokeless tobacco led to a higher risk of myocardial infarction (heart attack) and death from coronary heart disease. Pipe use was associated with a higher risk of heart failure.
Statistical analysis demonstrated that cigarette smoking was consistently associated with higher risk for all the heart health outcomes studied. People who used only cigars, pipes, or smokeless tobacco without cigarettes had higher risks of many cardiovascular diseases compared to people who never used these products.
This was an observational cohort study, meaning researchers examined the data involving a large group of people to consider how their tobacco use affected their health. The study did not take into consideration other heart-health risk factors, such as nutrition, exercise, and stress levels. Yet this important research gives patients and providers more reason to discuss the effects of non-cigarette tobacco products on cardiovascular health.
And while this study did not examine e-cigarettes, we know from numerous other studies that using these products also comes with increased health risks, particularly to the cardiovascular system and the lungs.
Changing how we talk about tobacco
While I always talk with my patients about the dangers of cigarette smoking, we often don’t discuss whether they dip or smoke a pipe or cigars.
This research will change the discussions I have with my patients. Along with common conversations about family history and genetics—as well as diabetes, blood pressure, and cholesterol—I encourage all care providers to examine how they screen for tobacco use among their patients and to ensure they’re discussing how non-cigarette products can affect heart health.
Patients, too, can get clarity from this study. It’s clear that smoking a cigar or dipping snuff is not “safe.” All tobacco products harm your health, forcing your body to contend with addictive pollutants with serious health outcomes that can all shorten your life dramatically.
If you use tobacco products, there’s no better time than now to quit and start improving your health. Talk with your doctor about programs to help you quit—your heart will thank you.
More information:
Erfan Tasdighi et al, Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2024.53987
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UT Southwestern Medical Center
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How using cigars, pipes or smokeless tobacco can harm your heart (2025, March 18)
retrieved 19 March 2025
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