Nicotine is absorbed in substantial quantities from smokeless tobacco and could contribute to the adverse consequences of smokeless tobacco use. Chronic systemic exposure to nicotine could contribute to accelerated coronary artery disease, acute cardiac ischemic events, and hypertension. Systemic absorption of sodium and mutagenic chemicals from smokeless tobacco could aggravate hypertension or cardiac failure, or contribute to cancer, respectively. Information concerning the potential hazards of nicotine and other systemically absorbed toxins may be incorporated into educational programs to discourage the use of smokeless tobacco.
Benowitz NL (1996). Pharmacology of nicotine: Addiction and therapeutics . Ann Rev Pharmacol Toxicol36:597-613.
5.
Benowitz NL, Kuyt F., Jacob P. III (1984). Influence of nicotine on cardiovascular and hormonal effects of cigarette smoking. Clin Pharmacol Ther36:74-81.
6.
Benowitz NL, Porchet H., Sheiner L., Jacob P. III (1988). Nicotine absorption and cardiovascular effects with smokeless tobacco use: Comparison with cigarettes and nicotine gum. Clin Pharmacol Ther44:23-28.
7.
Benowitz NL, Jacob P. III, Yu L. (1989). Daily use of smokeless tobacco: Systemic effects . Ann Intern Med111:112-116.
8.
Benowitz NL, Porchet H., Jacob P. III (1990). Pharmacokinetics, metabolism, and pharmacodynamics of nicotine. In: Nicotine psychopharmacology: Molecular, cellular and behavioral aspects. Wonnacott S, Russell MAH, Stolerman IP, editors. Oxford: Oxford University Press, pp. 112-157.
9.
Bolinder GM, Ahlborg BO, Lindell JH (1992). Use of smokeless tobacco: Blood pressure elevation and other health hazards found in a large-scale population survey. J Int Med232:327-334.
10.
Bolinder G., Alfredsson L., Englund A., deFaire U. (1994). Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Am J Public Hlth84:399-404.
11.
Craig WY, Palomaki GE, Haddow JE (1989). Cigarette smoking and serum lipid and lipoprotein concentrations: An analysis of published data. Br Med J298:784-788.
12.
Eliasson M., Lundblad D., Hagg E. ( 1991). Cardiovascular risk factors in young snuff-users and cigarette smokers. J Int Med230:17-22.
13.
Folts JD, Bonebrake FC (1982). The effects of cigarette smoke and nicotine on platelet thrombus formation in stenosed dog coronary arteries: Inhibition with phentolamine. Circulation65:465-469.
14.
Gritz ER, Baer-Weiss V., Benowitz NL, Van Vunakis H., Jarvik ME (1981). Plasma nicotine and cotinine concentration in habitual smokeless tobacco users. Clin Pharmacol Ther30:201-209.
15.
Hellerstein MK, Benowitz NL, Neese RA, Schwartz J., Hoh R., Jacob P. III, et al. (1994). Effects of cigarette smoking and its cessation on lipid metabolism and energy expenditure in heavy smokers. J Clin Invest93:265-272.
16.
Henningfield JE, Fant RV, Tomar SL (1997). Smokeless tobacco: An addicting drug. Adv Dent Res11 :330-335.
17.
Holm H., Jarvis MJ, Russell Mah, Feyerabend C. (1991). Nicotine intake and dependence in Swedish snuff takers. Psychopharmacol108:507-511.
18.
Huhtasaari F., Asplund K., Lundberg V., Stegmayr B., Wester PO (1992). Tobacco and myocardial infarction: Is snuff less dangerous than cigarettes? Br Med J305:1252-1256.
19.
McPhaul M., Punzi HA, Sandy A., Borganelli M., Rude R., Kaplan NM (1984). Snuff-induced hypertension in pheochromocytoma . J Am Med Assoc252:2860-2862.
20.
Schroeder KL, Chen Msj (1985). Smokeless tobacco and blood pressure (letter) . N Engl J Med312:919.
21.
Siegel D., Benowitz N., Ernster VL, Grady DG, Hauck WW (1992). Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players. Am J Public Hlth82:417-421.
22.
Wells DG, Rustick JM (1986). Hypertension from smokeless tobacco (letter). Anesthesiol65:339.
23.
Wennmalm A., Benthin G., Granstrom EF, Persson L., Peterson A., Winell S. (1991). Relation between tobacco use and urinary excretion of thromboxane A2 and prostacyclin metabolites in young men. Circulation83:1698-1704.
