{"doi":"10.1001/jamanetworkopen.2024.53987","title":"Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration","abstract":"Importance: Cardiovascular health outcomes associated with noncigarette tobacco products (cigar, pipe, and smokeless tobacco) remain unclear, yet such data are required for evidence-based regulation. Objective: To investigate the association of noncigarette tobacco products with cardiovascular health outcomes. Design, Setting, and Participants: This cohort study was conducted within the Cross Cohort Collaboration Tobacco Working Group by harmonizing tobacco-related data and conducting a pooled analysis from 15 US-based prospective cohorts with data on the use of at least 1 noncigarette tobacco product ranging between 1948 and 2015. The analysis for this study was conducted between September 2023 and February 2024. The median (IQR) follow-up time for the all-cause mortality outcome was 13.8 (10.2-19.2) years. Exposure: Current, sole, and exclusive use of noncigarette tobacco products. Sole use refers to using a noncigarette tobacco product without currently smoking cigarettes. Exclusive use means using only the noncigarette tobacco product and never having smoked cigarettes. Main Outcomes and Measures: Myocardial infarction, stroke, heart failure, atrial fibrillation, total coronary heart disease, total cardiovascular disease (CVD), coronary heart disease mortality, CVD mortality, and all-cause mortality. Results: Of 103 642 participants (mean [SD] age, 55.7 [13.2] years; 49 550 female [47.8%] and 54 092 male [52.2%]), current use rates were 26 962 participants (26.3%) for cigarettes, 1147 participants (2.1%) for cigars, 530 participants (1.2%) for pipes, and 1410 participants (2.1%) for smokeless tobacco. Current cigar use was associated with stroke (hazard ratio [HR], 1.25; 95% CI, 1.01-1.55), atrial fibrillation (HR, 1.32; 95% CI, 1.13-1.53), and heart failure (HR, 1.29; 95% CI, 1.10-1.51) compared with never using cigars in the model adjusted for demographic and socioeconomic factors, cardiovascular risk factors, and cohort. Sole (HR, 1.34; 95% CI, 1.12-1.62) and exclusive (HR, 1.53; 95% CI, 1.20-1.96) cigar use was associated with stroke compared with never using cigars or cigarettes. Current pipe use was associated with heart failure (HR, 1.23; 95% CI, 1.01-1.49) compared with never using pipes, and sole pipe use was associated with myocardial infarction (HR, 1.43; 95% CI, 1.17-1.74) compared with never using pipes or cigarettes. Current use of smokeless tobacco was associated with coronary heart disease mortality (HR, 1.31; 95% CI, 1.08-1.59) and myocardial infarction (HR, 1.20; 95% CI, 1.03-1.39) compared with never using smokeless tobacco. Sole and exclusive smokeless tobacco use demonstrated associations with total CVD (HR, 1.34; 95% CI, 1.19-1.50 and HR, 1.34; 955 CI, 1.13-1.59, respectively), total coronary heart disease (HR, 1.41; 95% CI, 1.21-1.64 and HR, 1.36; 95% CI, 1.08-1.70, respectively), heart failure (HR, 1.41; 95% CI, 1.22-1.64 and HR, 1.70; 95% CI, 1.40-2.06, respectively), and cardiovascular (HR, 1.41; 95% CI, 1.20-1.65 and HR, 1.54; 95% CI, 1.24-1.91, respectively) and all-cause (HR, 1.46; 95% CI, 1.34-1.60 and HR, 1.39; 95% CI, 1.22-1.58, respectively) mortality compared with never using smokeless tobacco or cigarettes. Conclusions and Relevance: In this study, there were distinct risk patterns associated with the use of noncigarette tobacco products. These findings may carry implications for public health and regulation of noncigarette tobacco products.","journal":"JAMA Network Open","year":2025,"id":511953,"datarank":0.586645745904916,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.19078714646262715,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.19078714646262715,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":11,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.5484,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":71972,"name":"Zhiqi Yao","orcid":"0009-0007-7803-4357","position":1,"is_corresponding":false},{"id":892879,"name":"Kunal Jha","orcid":"0000-0002-3166-9335","position":2,"is_corresponding":false},{"id":284561,"name":"Zeina Dardari","orcid":"0000-0001-6026-3329","position":3,"is_corresponding":false},{"id":667959,"name":"Ngozi Osuji","orcid":"0000-0002-4772-8213","position":4,"is_corresponding":false},{"id":1322285,"name":"Tanuja Rajan","orcid":"0000-0003-3419-3560","position":5,"is_corresponding":false},{"id":653012,"name":"Ellen Boakye","orcid":"0000-0002-7625-9487","position":6,"is_corresponding":false},{"id":74999,"name":"Carlos J. Rodríguez","orcid":"0000-0003-0860-9008","position":7,"is_corresponding":false},{"id":22652,"name":"Kunihiro Matsushita","orcid":"0000-0002-7179-718X","position":8,"is_corresponding":false},{"id":264194,"name":"Eleanor M. Simonsick","orcid":"0000-0002-5460-3494","position":9,"is_corresponding":false},{"id":236911,"name":"João A.C. Lima","orcid":"0000-0001-8756-6995","position":10,"is_corresponding":false},{"id":310329,"name":"Rachel Widome","orcid":"0000-0001-6476-3478","position":11,"is_corresponding":false},{"id":283063,"name":"Debbie L. Cohen","orcid":"0000-0002-1325-315X","position":12,"is_corresponding":false},{"id":277163,"name":"Lawrence J. Appel","orcid":"0000-0002-0673-6823","position":13,"is_corresponding":false},{"id":259507,"name":"Amit Khera","orcid":"0000-0001-7255-6874","position":14,"is_corresponding":false},{"id":24967,"name":"Michael E. Hall","orcid":"0000-0002-5733-1025","position":15,"is_corresponding":false},{"id":1365774,"name":"Suzanne Judd","orcid":null,"position":16,"is_corresponding":false},{"id":246476,"name":"Shelley A. Cole","orcid":"0000-0002-2651-0127","position":17,"is_corresponding":false},{"id":24661,"name":"Ramachandran S. Vasan","orcid":"0000-0001-7357-5970","position":18,"is_corresponding":false},{"id":1034,"name":"Emelia J. Benjamin","orcid":"0000-0003-4076-2336","position":19,"is_corresponding":false},{"id":355675,"name":"Aruni Bhatnagar","orcid":"0000-0001-6818-0384","position":20,"is_corresponding":false},{"id":456720,"name":"Andrew P. DeFilippis","orcid":"0000-0002-5135-9748","position":21,"is_corresponding":false},{"id":71977,"name":"Michael J. Blaha","orcid":"0000-0001-5138-9683","position":22,"is_corresponding":false},{"id":1020091,"name":"Erfan Tasdighi","orcid":"0000-0003-2146-7083","position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:48:01.269605Z","pmid":"39804647","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}