The use of non-cigarette tobacco products, such as cigars, pipes, and smokeless tobacco, often flies under the radar compared to combustible cigarettes. However, these products pose distinct and significant risks to cardiovascular health. Recent research sheds light on the alarming hazards associated with their use, reinforcing the urgency for regulatory actions to safeguard public health.

Non-Cigarette Tobacco Products and Cardiovascular Risk

While cigarette use has declined over recent decades, the growing prevalence of alternative tobacco products remains a worrying public health challenge. These products are often marketed in ways that minimise their dangers, but a recent comprehensive study involving over 100,000 adults confirms that cigars, pipes, and smokeless tobacco contribute significantly to heart disease, strokes, and other cardiovascular conditions. Such findings dismantle the myth that these products are safer than traditional cigarettes.

As the American Cancer Society states, “There is no safe form of tobacco. Tobacco products like e-cigarettes, pipes, cigars, hookahs, heat-not-burn cigarettes, smokeless tobacco, and other products you put in your mouth have some of the same harmful chemicals as regular cigarettes”. This underscores the need for heightened awareness of the risks associated with these products.

Key Findings at a Glance

• Cigars: Current cigar use increases the risk of stroke, atrial fibrillation, and heart failure. Exclusive cigar use shows notably higher odds of strokes compared to non-users.
• Pipes: Pipe users face heightened risks of heart failure and myocardial infarction, undermining the perception of this product being harmless.
• Smokeless Tobacco: Associated with coronary heart disease mortality and myocardial infarction, smokeless tobacco demonstrates the broadest range of cardiovascular risks. It impacts nearly all observed heart health outcomes, even for individuals who solely use these products without a history of smoking cigarettes.

These results emphasise that no form of tobacco is risk-free. Across the categories, users experience varying degrees of harm, but the dangers are clear, consistent, and significant.

The Problem of Misplaced Perception

One of the most troubling aspects of non-cigarette tobacco products is their misleading public image. Flavoured cigars, in particular, are made more appealing to younger individuals, with flavours like cherry attracting the next generation of users. Similarly, pipes and hookah smoking are often associated with casual or social settings, making users underestimate their long-term effects on health. Smokeless tobacco, meanwhile, is frequently marketed as an alternative for individuals who want to avoid inhaling smoke, further perpetuating a false sense of safety.

These misconceptions are dangerous. They encourage experimentation and regular use among individuals who might avoid cigarettes due to their well-known risks. Meanwhile, users of non-cigarette tobacco products still expose themselves to severe harm, often unknowingly.

Distinct Health Risks Compared to Cigarettes

While the risks associated with non-cigarette tobacco products sometimes appear lower than those for cigarettes, the dangers are still profound. Cigarettes are widely understood to cause cardiovascular damage, but tobacco products such as cigars and smokeless options are not far behind in their devastating effects. Data from the study indicates that cigar use alone increases the risk of stroke by over 25%, while smokeless tobacco use links directly to coronary heart disease deaths.

It is important to note, however, that the lower prevalence of these products—in comparison to cigarettes—has historically hindered robust study and regulation. This limited awareness means that non-cigarette tobacco products are falsely perceived as lower in risk simply because the consequences are lesser known. But ignorance is no shield against their damaging outcomes, especially with new evidence emerging on their risks.

A Call for Stronger Regulation

Protecting public health requires swift and decisive action regarding all forms of tobacco use. Combustible cigarettes are already heavily regulated, but cigars, pipes, and smokeless tobacco often evade similar scrutiny. This loophole leaves individuals vulnerable to harm through products that may seem less harmful due to lenient oversight or inadequate warnings.

Tighter controls on these products, including restrictions on marketing techniques, flavour bans, and sales monitoring, are crucial. That is particularly urgent given that the adverse health effects of these products span a range of cardiovascular conditions, from heart attacks to strokes, all leading to a reduced quality of life or premature death.

Public Awareness Is Vital

While regulations play a central role in mitigating harm, public education remains paramount. Many people begin using cigars, pipes, or smokeless tobacco without understanding what is at stake. Raising awareness about the specific and serious risks associated with these products could deter usage and protect vulnerable populations, especially young people.

Communities, organisations, and healthcare professionals must unite to debunk the myths surrounding these products. Efforts should focus on clearly illustrating that “non-cigarette” does not mean “safe.” This messaging is especially critical for groups that are disproportionately targeted, such as young adults and socioeconomically disadvantaged communities.

Final Thoughts

The cardiovascular risks posed by cigars, pipes, and smokeless tobacco are clear and undeniable. These products are not safe alternatives to cigarettes; they are dangerous in their own unique ways. Immediate action—both regulatory and educational—is needed to expose the reality of their risks and to prevent further avoidable harm. Prioritising public health over tobacco profits is not simply a necessity; it is a moral obligation to future generations.

Source: JAMA Network