Association of Smokeless Tobacco Use With Incident Peripheral Artery Disease: Results From the Atherosclerotic Risk in Communities Study

Jeremy R. Van't Hof, Wendy Wang, Kunihiro Matsushita, Gerardo Heiss, Aaron R. Folsom, Rachel Widome, Pamela L. Lutsey

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Cigarette smoking is associated with an increased risk for peripheral artery disease. It is unknown whether smokeless tobacco, a noncombustible form of tobacco exposure, is also associated with increased peripheral artery disease risk. Using data from the Atherosclerosis Risk in Communities study, we tested the hypothesis that the use of smokeless tobacco is associated with a higher risk of developing peripheral artery disease. Methods: Participants with peripheral artery disease at baseline were excluded. Smokeless tobacco use was assessed 3 times from 1987 to 1995, and peripheral artery disease events accrued from 1987 to 2018. Smokeless tobacco was modeled as a time-dependent exposure in Cox regression models. Analyses were completed in 2021. Results: This study included 14,344 participants with a baseline mean (SD) age of 54.1 (5.7) years; 54.8% were female, and 26.4% were Black. There were 635 incident peripheral artery disease events over a median follow-up of 27.6 years (maximum of 32.1 years). The peripheral artery disease incidence rate was 4.44 per 1,000 person-years among those who used smokeless tobacco compared with 1.74 per 1,000 person-years for those who did not. The hazard ratio for current versus never smokeless tobacco use was 1.94 (95% CI=1.31, 2.88) after adjustment for sociodemographic characteristics and cigarette smoking. Peripheral artery disease incidence rate among those currently using smokeless tobacco was similar to that of those who currently smoke cigarette (3.39 per 1,000 person-years). Conclusions: Current smokeless tobacco use was associated with high rates of peripheral artery disease, similar to cigarette smoking. Future research should evaluate the effect of cessation of noncombustible tobacco on incident peripheral artery disease.

Original languageEnglish (US)
Pages (from-to)728-733
Number of pages6
JournalAmerican journal of preventive medicine
Issue number5
StatePublished - May 2023

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, NIH, Department of Health and Human Services under contract Numbers 75N92022D00001 , 75N92022D00002 , 75N92022D00003 , 75N92022D00004 , and 75N92022D00005 . GH is deceased.

Publisher Copyright:
© 2023 American Journal of Preventive Medicine

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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