Top Things to Know: Impact of Smokeless Oral Nicotine Products on Cardiovascular Disease: Implications for Policy, Prevention and Treatment
Published: December 03, 2024
- Smokeless oral nicotine products have harmful effects on health. Use of these products has potential adverse effects on several biomarkers of cardiovascular disease risk and can increase oral cancer risk. Products vary considerably in composition, toxicant profiles and associated health risk.
- There is strong potential for ongoing nicotine addiction with the use of smokeless oral nicotine products as they tend to deliver substantial amounts of nicotine and are often used in addition to combustible cigarettes or other tobacco products, contributing to dual or poly-use.
- Among adults, 2.1% (5.2 million) report current use of smokeless oral nicotine products. Among youth, 1.5% (400,000 students) report current use. Newer categories of smokeless oral nicotine products marketed as tobacco-free products are gaining popularity, particularly among youth and young adults.
- While there are no safe tobacco products, a continuum of risk across tobacco and oral nicotine products exists, with the greatest risk associated with combustible products, such as cigarettes and cigars. Cardiovascular risks with smokeless tobacco use are lower compared to cigarette smoking, but there are still cardiovascular risks.
- Snuff is noncombustible finely ground tobacco, which is available moist or dry, and loose or in pouches. Moist snuff (i.e., “dip”) is cured, fermented tobacco that is pinched and placed in between the cheek and gum and requires spitting. One moist snuff product, Copenhagen Classic Snuff, has been designated by the Food and Drug Administration as a “modified-risk tobacco product because switching completely to this product from smoking tobacco may reduce the risk of lung cancer.”
- Snus is a type of moist snuff that is often packaged in small “teabag like” pouches that are placed between the upper cheek and gums, and, unlike snuff, does not require spitting. Several snus products were authorized by the Food and Drug Administration as “modified-risk tobacco products” as they may be less harmful to health when used instead of combustible cigarettes.
- Synthetic nicotine (vs. tobacco-derived nicotine) is being used in several brands of oral nicotine products. The range of these tobacco-free oral nicotine products being sold has rapidly proliferated and includes oral nicotine pouches; non-therapeutic nicotine gums, lozenges, and tablets; and nicotine gummies have rapidly proliferated. The sales of oral nicotine pouches, in particular, have increased substantially.
- Because they were only recently introduced to the marketplace, there are currently no data available regarding the cardiovascular or health risks of synthetic nicotine and tobacco-products oral nicotine products. Data on the relative cardiovascular disease risk of different smokeless oral nicotine products are limited.
- Further research is necessary to better understand the public health impact of smokeless oral nicotine products, the association of these products with continued tobacco use and tobacco use cessation, and the initiation of use of these products among youth.
- Robust public policy actions can help end addiction to all commercial tobacco and nicotine products. Along with policy initiatives, it is critical for clinicians to emphasize the prevention of tobacco product initiation and support cessation using established pharmacological and behavioral tobacco dependence treatment therapies.
Citation
Dennison Himmelfarb CR, Benowitz NL, Blank MD, Bhatnagar A, Chase PJ, Davis EM, Fetterman JL, Keller-Hamilton B, Ogungbe O, Page RL 2nd, Rezk-Hanna M, Robertson RM, Whitsel LP; on behalf of the American Heart Association Advocacy Coordinating Committee. Impact of smokeless oral nicotine products on cardiovascular disease:implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation. Published online December 3, 2024. doi: 10.1161/CIR.0000000000001293