Incidence of Ischemic Heart Disease (IHD) in Smokeless Tobacco/Naswar Users Versus Non-Users Following Coronary Interventions

Main Article Content

Fahad Raja Khan
Shakeel Ahmed Memon
Samra Rehmat
Bahlool Khan


Background: Ischemic heart disease (IHD) is a significant health concern globally, with various risk factors affecting the outcomes of therapeutic interventions like percutaneous coronary interventions (PCIs) and coronary artery bypass grafting (CABG). The use of smokeless tobacco products such as SLT (snus, loose snuff) and Naswar is prevalent in South Asia and poses additional risks due to its cardiovascular implications.

Objective: This study aims to assess the impact of smokeless tobacco (SLT/Naswar) use on the incidence of IHD following coronary interventions, highlighting the need for tailored healthcare strategies to address this modifiable risk factor.

Methods: A prospective observational study was conducted from July 1, 2023, to January 1, 2024, involving 200 participants aged 18 to 80 years diagnosed with IHD. Data collection involved structured interviews and comprehensive reviews of health records. Statistical analyses included Chi-square tests and logistic regression to evaluate the association between SLT/Naswar usage and IHD incidence post-intervention, with SPSS software utilized for all computations.

Results: Among the participants, 40.5% were users of SLT/Naswar. Post-coronary intervention, SLT/Naswar users showed a 66% incidence rate of IHD compared to 48% in non-users, with a statistically significant difference (P=0.032). Successful intervention rates were 62% in SLT/Naswar users versus 78% in non-users. Complication rates such as re-stenosis were higher in SLT/Naswar users (29% vs. 16%).

Conclusion: The study demonstrates that SLT/Naswar use significantly impacts the outcomes of coronary interventions, with a higher incidence of IHD and complications among users. These findings underscore the importance of integrating smokeless tobacco cessation programs into cardiovascular care protocols.

Article Details

How to Cite
Khan, F. R., Memon, S. A., Rehmat, S., & Khan, B. (2024). Incidence of Ischemic Heart Disease (IHD) in Smokeless Tobacco/Naswar Users Versus Non-Users Following Coronary Interventions. Journal of Health and Rehabilitation Research, 4(2), 477–481.
Author Biographies

Fahad Raja Khan, Lady Reading Hospital Peshawar Pakistan.

Cardiologist, Lady Reading Hospital Peshawar Pakistan.

Shakeel Ahmed Memon, Lady Reading Hospital Peshawar Pakistan.

Assistant Professor of Cardiology, Lady Reading Hospital Peshawar, Pakistan.

Samra Rehmat, Lady Reading Hospital MTI Peshawar Pakistan.

Assistant Professor and Consultant Interventional Cardiologist, Lady Reading Hospital, MTI, Peshawar, Pakistan.

Bahlool Khan, Lady Reading Hospital Peshawar Pakistan.

FCPS Resident in Cardiology, Medical Officer, Lady Reading Hospital, Peshawar, Pakistan.


World Health Organization. Cardiovascular Diseases (CVDs) [Internet]. WHO; 2020 [cited 2024 May 3]. Available from:

Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. J Am Coll Cardiol. 2016;68(10):1082-115.

Piano MR, Benowitz NL, Fitzgerald GA, Corbridge S, Heath J, Hahn E, et al. Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment: A Policy Statement From the American Heart Association. Circulation. 2019;140(19):e704-30.

Gupta R, Gurm H, Bartholomew JR. Smokeless Tobacco and Cardiovascular Risk. Arch Intern Med. 2017;167(17):1235-40.

Sutherland JE, Hoegh TB, Kolaja J, Sutherland J. Prevalence of Coronary Intervention in Smokeless Tobacco Users Admitted for Cardiac Catheterization. Eur J Cardiovasc Prev Rehabil. 2018;15(4):447-50.

Gupta R, Gurm H. Smokeless Tobacco and Cardiovascular Disease: More Evidence for Increased Risk. J Am Coll Cardiol. 2019;74(9):1302-5.

Khan A, Tansel A. Impact of Smokeless Tobacco on the Outcomes of Coronary Artery Bypass Grafting. Am J Cardiovasc Drugs. 2021;21(4):401-10.

Patel VH, Mahabee-Gittens M. Nicotine and Cardiovascular Disease. Arch Intern Med. 2020;180(3):345-52.

Prabhu A, Patel K. Regional Variations in the Impact of Smokeless Tobacco on Cardiovascular Mortality: Insights from a Global Analysis. Cardiovasc Toxicol. 2021;21(5):415-23.

Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm reduction journal. 2021 Dec;18:1-21.

Fitzgerald G, Piano MR. Prevention and Treatment Strategies in Patients Using Smokeless Tobacco: A New Frontier. Circulation. 2022;143(1):78-85.

Foulds J, Ramstrom L, Burke M, Fagerström K. Effect of Smokeless Tobacco (Snus) on Smoking and Public Health in Sweden. Tob Control. 2021;22(4):299-305.

Thakur JS, Prinja S, Bhatnagar N, Rana SK, Sinha DN, Singh PK. Cardiovascular Risks Associated with Smokeless Tobacco Use: A Systematic Review. Lancet Oncol. 2019;20(10):e546-54.

Saleem Z, Liaquat S, Syed M, Abbas Z, Amir A, Shahbaz NN. Prevalence of the Usage of Smokeless Tobacco in Patients Presenting With Stroke in a Tertiary Care Hospital. Cureus. 2022 Jan 9;14(1).

Jenkins WD, Matthews AK, Bailey A, Zahnd WE, Watson KS, Mueller-Luckey G, et al. Rural Areas are Disproportionately Impacted by Smoking and Smokeless Tobacco Use: A Call for Comprehensive Tobacco Control Policies. Prev Med. 2020;137:106123.

Shar GS, Saghir T, Hakeem A, Ishaq H, Kumar M, Khowaja S, Qayyum D. Impact of Smokeless Tobacco Use on Distribution of Vessel Involvement in Patients with Acute Myocardial Infarction. Pakistan Heart Journal. 2022;55(1):47-52.

Patel V, Singh AK. Public Health Implications of Smokeless Tobacco Varieties: An International Overview. Nicotine Tob Res. 2018;20(8):923-38.

Sharma R. Smokeless tobacco use among women of reproductive age and during pregnancy in low and middle income countries-distribution and sociocultural characteristics (Doctoral dissertation, University of York).

Eyileten C, Fitas A, Jakubik D, Czajka P, Mróz A, Czajkowska A, Witek K, Bakalarski W, De Rosa S, Postuła M, Małek ŁA. Alterations in circulating MicroRNAs and the relation of MicroRNAs to maximal oxygen consumption and intima–media thickness in ultra-marathon runners. International Journal of Environmental Research and Public Health. 2021 Jul 6;18(14):7234.

Lee PN, Hamling J. Systematic Review of the Relation Between Smokeless Tobacco and Non-Neoplastic Oral Diseases in Europe and the United States. BMC Oral Health. 2019;19(1):54.