Using Noncigarette Tobacco Increases Your Risk of Heart Disease

• Participants included both smokers and non-smokers of cigarettes — Researchers grouped people as “sole users” if they used only one type of noncigarette tobacco but had smoked cigarettes in the past, and “exclusive users” if they used cigars, pipes, or smokeless tobacco but never smoked cigarettes. This made it easier to see whether the health risks came from the noncigarette products themselves, not from past cigarette use.

• Cigar use sharply raised the risk for multiple heart-related outcomes — Sole cigar use was linked to a 34% higher risk of stroke. For exclusive cigar users, the risk was 53% higher than those who never smoked cigars or cigarettes.

• Cigar users also increased atrial fibrillation and heart failure risks — Cigar use raised the risk of atrial fibrillation (irregular heartbeat) by 32% and heart failure by 29%, even after adjusting for age, socioeconomic factors, and known cardiovascular risks. Both conditions are major contributors to stroke, heart attack, and sudden cardiac death.

• Pipe smoking was not safe either — Pipe smokers were 23% more likely to develop heart failure compared to those who never smoked pipes. This applied whether or not they had ever smoked cigarettes, showing that the risk is tied to the product itself.

• Smokeless tobacco caused even broader cardiovascular damage — Exclusive smokeless tobacco users had a 34% higher risk of total cardiovascular disease and a 39% increase in all-cause mortality. That means chewing tobacco and snuff, often promoted as safer alternatives to smoking, are actually fueling heart attacks and early death.

• Tobacco was linked to cardiovascular death — People who currently used smokeless tobacco were more likely to die from coronary heart disease, with a 31% higher risk of CHD-related death. They also had higher risks for heart attacks and other forms of cardiovascular disease.

• Exclusive users of smokeless tobacco faced even more pronounced risks — People who had never smoked cigarettes but currently used only smokeless tobacco had a 70% higher risk of heart failure and a 66% higher risk of dying from CHD. They also had a 54% higher risk of dying from cardiovascular causes and a 39% higher risk of all-cause mortality.

• Oxidative stress, clotting, and inflammation form a vicious cycle — Tobacco smoke generates reactive oxygen species (ROS), creating oxidative stress that damages blood vessel walls. This triggers inflammation and increases clotting potential.

At the same time, tobacco suppresses protective agents like prostacyclin and boosts pro-clotting factors like thromboxane A2. The result is a hypercoagulable, inflamed vascular system primed for stroke and heart attack.

• Harmful compounds found in tobacco — One of the toxins found in tobacco is nicotine, which stimulates the sympathetic nervous system, raising heart rate, increasing blood pressure, and constricting vessels. Its smoke also has carbon monoxide, which reduces the blood’s oxygen-carrying capacity by displacing oxygen into red blood cells.⁷

Heavy metals such as arsenic, cadmium, and lead, also present in tobacco, further disrupt mitochondrial function, impair detox pathways, and worsen long-term cardiovascular stress.

• Secondhand smoke triggers the same cardiovascular responses — Even brief exposure to secondhand smoke impairs endothelial function within 30 minutes. The review cited a 30% increase in stroke and coronary events in non-smokers regularly exposed to tobacco smoke. These findings apply whether the source is cigarettes or cigars; once airborne, the toxins behave the same.

• Cardiovascular damage persists long after quitting — While quitting reduces risk over time, former smokers still had elevated cardiovascular risk for more than a decade after stopping. The review reinforced that even moderate use or partial quitting fails to reverse the biological damage caused by long-term tobacco exposure.

• PAHs are formed when tobacco is burned — These are toxic, cancer-causing chemicals released through combustion. Cigarettes, cigars, and pipes all generate PAHs during smoking. Once inhaled, they bind to DNA and drive mutations.

• TSNAs are created during tobacco curing and processing — Unlike PAHs, TSNAs don’t require burning to cause harm. They’re absorbed through oral tissues with smokeless tobacco or from cigar and pipe smoke. Once in the body, they promote genetic mutations and uncontrolled cell growth.

• These compounds damage DNA regardless of how tobacco is used — Whether you smoke or chew, these carcinogens enter your bloodstream and alter genetic material. The review emphasized that using noncigarette tobacco does not eliminate your cancer risk. Instead, it only changes the route of exposure.

• Noncigarette tobacco users had lower AHRR methylation — Compared to people who never used tobacco, exclusive users of cigars or pipes had significantly lower AHRR methylation levels. The reduction was less severe than in cigarette smokers, but still measurable, which confirms that tobacco use, even without inhaling, disrupts how your genes regulate detox and repair functions.

• Lower methylation was tied to respiratory symptoms — The study found that users with lower AHRR methylation were more likely to experience chronic cough, wheezing, and shortness of breath. They also had significantly higher all-cause mortality during the follow-up period. These associations were present even in those who never smoked cigarettes.

• Methylation at AHRR acts as marker for tobacco exposure — The authors noted that AHRR methylation could serve as a molecular marker for tobacco-related harm. Even in people who don’t report cigarette use, cigar and pipe exposure was enough to trigger this genetic change. That makes it a reliable indicator of internal damage, even when other signs haven’t yet appeared.

• Tobacco exposure weakens the body’s ability to repair DNA — Tobacco smoke interferes with enzymes that maintain methylation patterns. When this happens, your body becomes less able to silence damaged DNA or repair genetic errors. The result is increased vulnerability to mutations, cancer, and accelerated aging, even from noncigarette tobacco products.

1. Don’t swap one addiction for another — While it’s tempting to replace noncigarette tobacco with a vape or e-cigarettes, these products will still keep you addicted to nicotine and often at higher doses. You’re not breaking the addiction, just changing its form. Instead, redirect your focus toward restoring your health and building a more resilient routine.

Learn more about the harmful effects of e-cigarettes to your heart health in “Shock Study Finds E-Cigarettes May Raise Risk of Heart Failure.”

2. Stay physically active to reduce cravings — Cravings are more likely to hit when your body and mind are idle. Building structure into your day through consistent movement helps reduce those vulnerable moments.

Take daily walks, do short bursts of stretching, or perform simple tasks that keep your hands engaged, like tidying up or cooking, to shift your focus. Regular activity also supports your body’s stress response and speeds up the removal of nicotine from your system.

3. Use mind-body strategies to support your journey — Tools like the Emotional Freedom Techniques (EFT) help regulate the stress and emotional buildup that drive the urge to use tobacco. There are mindfulness-based apps that also provide structured breathing exercises, timed check-ins, or guided prompts to keep you grounded throughout the day.

These tools help retrain your response when the impulse to reach for tobacco surfaces, replacing old patterns with greater awareness and control. To learn more about how to use mindfulness and EFT to quit tobacco use, read “Quitting Smoking Starts in the Brain.”

4. Recognize your triggers and create new responses — The urges to use tobacco often follow familiar routines or emotional cues. Begin by observing the specific situations that tend to prompt those cravings. Does it happen during your morning routine, after dealing with stress, or when you’re feeling restless?

Once you pinpoint these moments, you can prepare intentional substitutes. If drinking coffee sparks the urge, try changing your beverage or shifting your focus to a quick task, like making a checklist or reorganizing your space, until the craving passes. Anticipating and redirecting these triggers is key to breaking the cycle.

5. Establish firm boundaries — Hiding cigarettes might seem like a first step, but it’s not enough. A more effective approach is to completely eliminate all tobacco-related items from your environment. This includes lighters, ashtrays, and any remaining products in your home, car, or personal spaces.

Pay close attention to locations where the habit is most ingrained, whether it’s your kitchen, porch, or a specific chair. Once identified, redefine those spaces as strictly tobacco-free. This sends an unmistakable message to your brain that nicotine no longer belongs to those locations, and those routines no longer apply.