For decades, the health risks of cigarette smoking have been well understood. In the U.S., smoking causes nearly one in five deaths each year, with many linked to cancer. But what’s less widely known is that people who smoke are actually more likely to die from heart disease than from lung cancer.
And now, new research is shedding light on the dangers of other tobacco products too—like cigars, pipes, and smokeless tobacco such as dip or snuff.
A recent study led by researchers at Johns Hopkins, with help from UT Southwestern and other institutions, reveals that these non-cigarette tobacco products also pose serious risks to heart health.
Published in JAMA Network Open, the study gathered and analyzed health data from more than 103,000 adults across 15 different long-term studies in the U.S., spanning from 1948 to 2015. It’s the most comprehensive study to date focusing on how non-cigarette tobacco use affects the heart and blood vessels.
Cigarette Use Has Declined—but Other Tobacco Use Hasn’t
Today, fewer people smoke cigarettes than ever before. In the 1960s, nearly half of American adults smoked. By 2022, that number had dropped to just under 12%. Despite this progress, people continue to use other forms of tobacco at similar rates to past decades. According to the Centers for Disease Control and Prevention (CDC) in 2021:
- 3.5% of U.S. adults smoked cigars
- 0.9% used pipes or hookahs
- 2.1% used smokeless tobacco like dip or snuff
Unlike cigarette packs, these products often don’t carry graphic health warnings. Many people believe they’re safer—but this new research shows that’s not true.
What the Study Found
Researchers discovered that every type of tobacco product studied raised the risk of specific heart and blood vessel problems. These include:
- Cigars – Increased risk of stroke, atrial fibrillation (irregular heartbeat), and heart failure
- Smokeless tobacco (dip, snuff) – Higher risk of heart attacks and death from coronary heart disease
- Pipes – Linked to a greater risk of heart failure
These findings held true even for people who never smoked cigarettes but only used cigars, pipes, or smokeless tobacco. Compared to people who had never used any tobacco, non-cigarette users still had significantly higher risks of cardiovascular disease.
This was an observational study, which means researchers looked at patterns in people’s health and tobacco use over time, rather than conducting experiments. It didn’t control for all other lifestyle factors—like diet, exercise, or stress—but the size of the study makes the findings important and trustworthy.
Why Tobacco Hurts the Heart
All tobacco products contain nicotine, a highly addictive substance. Nicotine and other chemicals in tobacco cause inflammation and damage inside the body—especially in the blood vessels. This can lead to:
- Atherosclerosis – Plaque buildup in arteries
- High blood pressure – Making the heart work harder
- Increased heart rate – Adding more strain
- Reduced oxygen – Smoking produces carbon monoxide, which limits oxygen in the bloodstream
- Higher cholesterol – Promoting more plaque in arteries
Over time, these effects make heart attacks, strokes, and heart failure more likely.
What This Means for Patients and Healthcare Providers
Many people understand the risks of cigarettes, but this study sends a clear message: no tobacco product is safe. Whether it’s a cigar after dinner, occasional pipe smoking, or regular dipping—each can seriously harm your heart.
Dr. John Krystal, Editor of Biological Psychiatry, put it simply: “This study should change how we talk about tobacco.” It’s time for doctors and patients to go beyond asking, “Do you smoke cigarettes?” They should ask about all forms of tobacco use and explain the risks clearly.
This research may also push policymakers to reconsider how they regulate and label non-cigarette tobacco products, which are often left out of public health campaigns and warning systems.
Review and Analysis
This study marks a turning point in our understanding of tobacco’s impact on cardiovascular health. It challenges the long-standing belief that some tobacco products—especially cigars or smokeless forms—are less harmful than cigarettes. They are not. The findings show a clear connection between these products and major heart problems, including strokes, heart attacks, and heart failure.
The strength of this study lies in its size and scope. By combining data from multiple long-term studies, researchers could finally analyze smaller groups of cigar and smokeless tobacco users with enough detail to see the health effects clearly.
Although the study didn’t control for every possible health factor, its findings align with what we already know about how nicotine and tobacco chemicals affect the body. And with the rise of new nicotine products like e-cigarettes—which were not part of this study—this message becomes even more urgent.
If you’re using tobacco in any form, this research offers a strong reason to quit. Talk to your doctor about tools and programs that can help. Whether you’re smoking, dipping, or using nicotine in another form, your heart will be better off without it.
If you care about heart health, please read studies about top foods to love for a stronger heart, and why oranges may help fight obesity, diabetes, and heart disease.
For more health information, please see recent studies about simple guide to a 7-day diabetes meal plan, and why you should add black beans to your plate.
The research findings can be found in JAMA Network Open.
Copyright © 2025 Knowridge Science Report. All rights reserved.
