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Effects of treatment on cardiovascular risk among smokeless tobacco users
S S Allen1, D Hatsukami, J Jensen
1Department of Family Practice, University of Minnesota Medical School, Minneapolis 55455, USA.
Background:
Studies show sustained levels of nicotine among young males using smokeless tobacco, causing concern for subsequent cardiovascular risk. Also, there is little information on effects of nicotine replacement on cardiovascular risk in cessation programs. This study investigates the effects of nicotine gum replacement in smokeless tobacco cessation on cardiovascular risk factors.
Methods:
Smokeless tobacco users, ages 18-65, were randomly assigned in a double-blind fashion to 2-mg nicotine or placebo gum. At baseline, Week 4, and Week 8, dependent measurements, heart rate, blood pressure, and weight were recorded, and fasting lipoprotein profiles were drawn.
Results:
This paper focuses on the smokeless tobacco users who refrained from use during the study period (N = 56). The nicotine gum group weighed less (P = 0.033) than the placebo group throughout the study and weight increased at a significant rate between Weeks 4 and 8 for both groups as gum decreased. Triglycerides were higher for the nicotine gum group than the placebo group (P = 0.031), with triglycerides decreasing between Weeks 4 and 8, with a similar effect seen among nonabstinent smokeless tobacco users. There was no dose, time, or dose by time effect for the other dependent measures.
Conclusions:
Among smokeless tobacco users who were abstinent, weight increased, with subjects on nicotine gum weighing less throughout the study. The lipoprotein profile, heart rate, and blood pressure did not improve over time, contrary to smokers in whom HDL increases and heart rate decreases with cessation. This could relate to different routes of administration, pharmacokinetics, or by-products of tobacco smoking being absent in smokeless tobacco. In addition, nicotine gum appeared to have neither an adverse nor a positive effect on heart rate, blood pressure, LDL, HDL, or total cholesterol.
Insights
Nicotine gum use in smokeless tobacco cessation led to lower weight but higher triglycerides. Cardiovascular risk factors like blood pressure and cholesterol did not improve, unlike in smokers who quit.
Area of Science:
- Cardiovascular Health
- Tobacco Cessation Research
- Pharmacology
Background:
- Sustained nicotine from smokeless tobacco (ST) raises cardiovascular (CV) risk concerns in young males.
- Limited data exists on nicotine replacement therapy (NRT) effects on CV risk during ST cessation.
- This study examines nicotine gum's impact on CV risk factors in ST cessation.
Purpose of the Study:
- To investigate the effects of 2-mg nicotine gum versus placebo on cardiovascular risk factors.
- To assess changes in weight, heart rate, blood pressure, and lipoprotein profiles during ST cessation with NRT.
- To compare outcomes with those observed in smoking cessation programs.
Main Methods:
- Double-blind, randomized trial of 2-mg nicotine gum versus placebo in ST users (ages 18-65).
- Measurements included heart rate, blood pressure, weight, and fasting lipoprotein profiles at baseline, week 4, and week 8.
- Analysis focused on abstinent ST users (N=56).
Main Results:
- Nicotine gum users weighed less than placebo users throughout the study (P=0.033).
- Triglycerides were higher in the nicotine gum group (P=0.031) but decreased over time.
- No significant effects on heart rate, blood pressure, LDL, HDL, or total cholesterol were observed.
Conclusions:
- Weight increased during ST cessation, with nicotine gum users maintaining lower weight.
- Cardiovascular risk factors (lipoprotein profile, heart rate, blood pressure) did not improve, unlike in smokers.
- Nicotine gum showed no adverse or beneficial effects on measured CV risk factors in abstinent ST users.