Latent coronary artery disease among smokers and smokeless tobacco users: a cross-sectional study


  • Dheerendra Kumar Mishra Department of Psychiatry, S. S. Medical College Rewa, Madhya Pradesh, India
  • Nimisha Mishra Department of Psychiatry, S. S. Medical College Rewa, Madhya Pradesh, India
  • Pradeep Kumar Department of Psychiatry, S. S. Medical College Rewa, Madhya Pradesh, India
  • Gyanendra Raghuvanshi Department of Psychiatry, S. S. Medical College Rewa, Madhya Pradesh, India



Exercise stress test, Smokeless tobacco, Tobacco smoking, Tobacco dependence, Treadmill test


Background: Tobacco related mortality and morbidity and increase in developing country like India. WHO projected till 2020 India will accounts 15% of tobacco related mortality especially preventable causes of death e.g. cardiovascular disease. Active tobacco smoking is undoubtedly major risk factor for cardiovascular disease, but subjects use smokeless tobacco in dependence pattern is not extensively evaluated for cardiovascular risk factor. In India smokeless tobacco especially Khaini is major form of tobacco consumption. Scarcity of data on effects of smokeless tobacco in cardiovascular disease especially coronary artery disease major limiting factor for undermine the detailed evaluation of cardiovascular effects in smokeless tobacco dependence subjects. The aim of the study was to study the risk of coronary artery disease among smokeless tobacco dependence in comparison to tobacco dependence smokers.

Methods: Cross-sectional assessments were done on 36 adults (>18 years), treatment-seeking patients with a ICD 10 diagnosis of Mental and behavioral disorders due to use of tobacco. Data was collected on socio-demographic characteristics, and after detailed clinical evaluation treadmill exercise test was done.

Results: Mean age of tobacco dependence smokers 51.5±9.6 years vs 53.6±7.5 years. There were male predominant in study subjects and 38% subjects was treadmill test positive. Smokeless tobacco users had 35% positive treadmill test, and among Smokers 42% subjects was positive for treadmill test.

Conclusions: Risk for latent coronary artery disease was similarly higher in smokers and smokeless tobacco dependence subjects.


Heckewelder, John Gottlieb Ernestus. History, manners, and customs of the Indian nations who once inhabited Pennsylvania and the neighboring states. Philadelphia; 1881.

Edward K. Balls. California Natural History Guides. Early Uses of California Plant. University of California Press; 1962.

Proctor RN. The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933-45. BMJ. 1996 Dec 7;313(7070):1450-3.

Tobacco or Health: A Global Status Report. Find in a Library with WorldCat, 22 Jan. 2018, Available at:

Jha P, Ranson MK, Nguyen SN, Yach D. Estimates of global and regional smoking prevalence in 1995 by age and sex. Am J Public Health. 2002;92:1002-6.

Shimkhada R, Peabody JW. Tobacco control in India. Bulletin of the World Health Organization. 2003;81:48-52.

Kumar S. India steps up anti-tobacco measures. Lancet. 2000;356:1089.

Organization, W. Tobacco or health : A global status report. [online] 2018. Available at: [Accessed 6 Mar. 2018].

Singh A, Ladusingh L. Prevalence and Determinants of Tobacco Use in India: Evidence from Recent Global Adult Tobacco Survey Data. PLoS ONE. 2018;9(12):e114073.

Haheim LL, Holme I, Hjermann I, Leren P. The predictability of risk factors with respect to incidence and mortality of myocardial infarction and total mortality. A 12-year follow-up of the Oslo Study, Norway. J Intern Med. 1993;234:17-24.

Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation. 1997;96:3243-7.

Glantz SA, Parmley WW. Passive smoking and heart disease. Mechanisms and risk. JAMA. 1995;273:1047-53.

European Network for Smoking Prevention. Smoke Free Workplaces: Improving the Health and Wellbeing of People at Work. Brussels: European Network for Smoking Prevention; 2001.

Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997;336:1276-82.

Wolf PA, D'Agostino RB, Kannel WB, Bonita R, Belanger AJ. Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA. 1988;259:1025-9.

Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989;298:789-94.

Nayak KC, Gett SS, Sharda DP, Misra SN. Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease. Indian Heart J. 1989 Jan-Feb;41(1):62-5.




How to Cite

Mishra, D. K., Mishra, N., Kumar, P., & Raghuvanshi, G. (2018). Latent coronary artery disease among smokers and smokeless tobacco users: a cross-sectional study. International Journal of Research in Medical Sciences, 6(4), 1179–1182.



Original Research Articles