Researchers from a major Midwestern university have uncovered a concerning link between smokeless tobacco use and peripheral artery disease PAD. The study, published in a respected medical journal, indicates that chewing tobacco and snuff may double the likelihood of developing this vascular condition, even when traditional smoking is taken into account. The findings contribute to a growing body of evidence about how tobacco products beyond cigarettes can affect heart and blood vessel health in both American and Canadian populations.
Peripheral arterial disease is an inflammatory condition that primarily compromises the arteries supplying the legs. When blood flow is restricted, people may experience pain, cramping, or weakness during movement, and in more advanced cases, wounds or ulcers on the feet and legs can occur due to insufficient oxygen and nutrient delivery. While smoking has long been linked to higher PAD risk, this new analysis shines a light on the impact of pure tobacco products used non-combustively and how they may harm vascular health in ways previously underappreciated.
The researchers drew on data from a large cohort of about 14,000 participants participating in a long-running, community-based study focused on atherosclerosis risk. The average age of participants at the start of the study was in the mid-50s, a critical period for identifying signals of cardiovascular risk that could influence later health outcomes across North America.
Incidence rates in the analysis showed that among users of smokeless tobacco, there were about 4.4 new cases of PAD per 1000 person-years. By comparison, cigarette smokers experienced roughly 3.4 new cases per 1000 person-years. For non-tobacco users, the rate stood at around 1.3 cases per 1000 person-years. After accounting for sociodemographic factors and established cardiovascular risk factors, smokeless tobacco use remained associated with roughly a twofold higher risk of PAD compared with non-users. These results underscore the reality that non-combustible products are not harmless to vascular health, a message that resonates with consumers in Canada and the United States who may differentially perceive risks associated with each form of tobacco use.
Non-combustible tobacco products such as chewing tobacco and snuff are often marketed—and perceived—as cleaner options because they do not involve burning tobacco. Yet this study demonstrates that their impact on the blood vessels can be just as meaningful as that of smoked products. The association with vascular inflammation and reduced blood flow is a reminder that any form of tobacco can carry significant cardiovascular consequences. In practical terms, clinicians in North America should consider smokeless tobacco use as a potential contributor to PAD risk when assessing a patient’s vascular health, particularly for adults in middle age who may be adopting or maintaining these products.
From a public health perspective, the findings emphasize the importance of broad education about tobacco-related risks. People who use smokeless products might assume they are avoiding the harms linked to smoking, but the evidence indicates that the risk profile for vascular disease remains elevated. Health professionals in Canada and the United States may use this information to counsel patients more effectively, highlighting that the absence of smoke does not equate to the absence of danger regarding the circulation system and limb health. With PAD already posing a significant burden in terms of mobility and quality of life, recognizing and reducing smokeless tobacco use becomes a practical step toward preserving leg health and overall well-being.
In summary, the study adds a critical dimension to our understanding of how nicotine and other tobacco constituents influence vascular biology. It invites a more nuanced view of risk that includes non-combustible forms of tobacco. For individuals considering tobacco cessation or prevention strategies, this research supports a broader message: quitting all tobacco products yields the greatest benefits for arterial health. Health authorities and clinicians across North America may incorporate these insights into screening and risk assessment protocols, helping populations detect PAD earlier and protect leg function over time.
Attribution: American Journal of Preventive Medicine, study on smokeless tobacco and peripheral artery disease.