Abstract:

Background: Smoking is a well-established cardiovascular risk factor for coronary artery disease (CAD), which is in a decremental trend among population over last few decades. Whereas use of smokeless tobacco is an establishing risk factor for CAD, which is in an incremental trend among population. Worldwide prevalence of use of smokeless tobacco is also higher than smoking among population. As amount of intake of tobacco, route of administration, rate of absorption, serum level of nicotine are different in both form of tobacco consumption, therefore clinical and angiographic patterns can be different in both cases.Objective:To compare and determine the difference in clinical and angiographic patterns of CAD between smokeless tobacco users and smokers.Materials and methods: Total 1848 patients attending catheterisation lab for coronary angiography with chief complain of angina or angina equivalent were enrolled in the study .Out of 1848 patients, 252 patients with history of tobacco consumption either in the form of smokeless or smoked tobacco without having any other cardiovascular risk factors for CAD were finally enrolled as study participants. Based on mode of consumption of tobacco, all study participants were categorised into two groupsi.e smokeless tobacco users group and smoker group. Data about clinical and angiographic patterns were compared between two groups.Results: Among smokers, prevalence of fatal coronary events like STEMI (32.4%), NSTEMI (29.6%) and multi vessel disease (27.7%) were significantly higher as compared to 15.2 %, 18%,19.4% cases among smokeless tobacco users respectively .On the contrary among smokeless tobacco users, prevalence of chronic stable angina (40.2%),single vessel disease(61.8%) were significantly higher as compared to 13.8%,48.1% casesamong smokersrespectively. While studying severity of lesion in patients with single vessel disease, 57.6 % patients in smoker group had occlusive(total or subtotal) lesion in comparison to 35.9% patients in smokeless tobacco user group with statistical significant P value.Conclusion: Prevalence of fatal coronary diseases, multi vessel diseases among smokeless tobacco usersis lower than that of smokers. However cardiovascular effects of smokeless tobacco can’t be ignored considering above facts. More than 1/3rd of smokeless tobacco users who presents to the catheterisation lab with angina or angina equivalent had fatal coronary artery disease and around 1/5th of the smokeless tobacco users with angina or its equivalent had multi vessel coronary artery disease.

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