{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:03:26Z","timestamp":1792242206783,"version":"4.4.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Cardiovascular health outcomes associated with noncigarette tobacco products (cigar, pipe, and smokeless tobacco) remain unclear, yet such data are required for evidence-based regulation.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association of noncigarette tobacco products with cardiovascular health outcomes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposure<\/jats:title>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.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 103\u202f642 participants (mean [SD] age, 55.7 [13.2] years; 49\u202f550 female [47.8%] and 54\u202f092 male [52.2%]), current use rates were 26\u202f962 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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.53987","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T16:01:24Z","timestamp":1736784084000},"page":"e2453987","source":"Crossref","is-referenced-by-count":16,"title":["Cigar, Pipe, and Smokeless Tobacco Use and Cardiovascular Outcomes From Cross Cohort Collaboration"],"prefix":"10.1001","volume":"8","author":[{"given":"Erfan","family":"Tasdighi","sequence":"first","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqi","family":"Yao","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunal K.","family":"Jha","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeina A.","family":"Dardari","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngozi","family":"Osuji","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanuja","family":"Rajan","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Boakye","sequence":"additional","affiliation":[{"name":"Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland"},{"name":"The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos J.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas"},{"name":"Division of Cardiovascular Medicine, Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor M.","family":"Simonsick","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o A. 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