Rahman Ihsanur, Ahmad Fayaz, Sadiq Naveed
Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Prev Med Rep. 2025 Jan 13;50:102963. doi: 10.1016/j.pmedr.2025.102963. eCollection 2025 Feb.
Tobacco use has a major impact on mortality from coronary artery disease (CAD). Naswar, a smokeless tobacco (SLT) product predominantly used in the northwestern part of Pakistan, has not been explored for its association with CAD. World Health Organization also expresses the need for further studies to thoroughly understand effects of different SLT products on CAD across various populations. This study explores the association between Naswar use and CAD in Peshawar, Pakistan.
This case-control study recruited 112 CAD cases and 112 controls from tertiary care hospitals between July 2021 and August 2022. Consecutive sampling facilitated data collection through interviews using pre-structured questionnaire. Multivariable logistic regression analyses computed adjusted odds ratios for Naswar-CAD association. Prior ethical approval from the authors' institute, and informed consent from participants were obtained prior to conduction of study.
There were statistically significant differences in age distribution, income levels, house ownership, family history of heart disease, comorbidities, and Naswar usage between cases and controls. Multivariable logistic regression showed that Naswar users (OR: 2.56, 95 % CI: 1.08-6.10), Naswar dip time of five or more minutes (OR: 3.77, 95 %CI: 1.11-12.84), 20+ years of Naswar use (OR: 4.30, 95 %CI: 1.26-14.75), black Naswar (OR: 2.62, 95 %CI: 1.04-6.60), and spitting Naswar saliva (OR: 3.76, 95 %CI: 1.43-9.86) exhibited higher adjusted odds of CAD compared to non-users of Naswar.
This study adds to the body of literature on significant association between Naswar use and CAD, emphasizing the necessity of regulating SLT products like Naswar to mitigate cardiovascular risks.
烟草使用对冠状动脉疾病（CAD）的死亡率有重大影响。纳斯瓦尔是一种主要在巴基斯坦西北部使用的无烟烟草（SLT）产品，其与CAD的关联尚未得到研究。世界卫生组织也表示需要进一步研究，以全面了解不同的无烟烟草产品对不同人群CAD的影响。本研究探讨了巴基斯坦白沙瓦地区纳斯瓦尔使用与CAD之间的关联。
本病例对照研究于2021年7月至2022年8月期间从三级护理医院招募了112例CAD病例和112名对照。连续抽样通过使用预先构建的问卷进行访谈来促进数据收集。多变量逻辑回归分析计算了纳斯瓦尔与CAD关联的调整比值比。在研究开展之前，获得了作者所在机构的伦理批准以及参与者的知情同意。
病例组和对照组在年龄分布、收入水平、房屋所有权、心脏病家族史、合并症和纳斯瓦尔使用情况方面存在统计学上的显著差异。多变量逻辑回归显示，与不使用纳斯瓦尔的人相比，使用纳斯瓦尔的人（比值比：2.56，95%置信区间：1.08 - 6.10）、纳斯瓦尔咀嚼时间为五分钟或更长时间的人（比值比：3.77，95%置信区间：1.11 - 12.84）、使用纳斯瓦尔20年及以上的人（比值比：4.30，95%置信区间：1.26 - 14.75）、黑色纳斯瓦尔使用者（比值比：2.62，95%置信区间：1.04 - 6.60）以及吐出纳斯瓦尔唾液的人（比值比：3.76，95%置信区间：1.43 - 9.86）患CAD的调整后几率更高。
本研究为纳斯瓦尔使用与CAD之间的显著关联增添了文献资料，强调了对纳斯瓦尔等无烟烟草产品进行监管以降低心血管风险的必要性。
