Effects of Smokeless Tobacco “maras Powder” Use on Markers of Endothelial Dysfunction

Aim: To compare brachial artery flow-mediated dilation (FMD) in subjects who use smokeless tobacco, smoke cigarettes, or do not use any tobacco product. Materials and methods: In the study, participants were 35 Maras powder users, 36 cigarette smokers and 30 nontobacco user subjects. Blood samples were collected and hematological parameters and lipid parameters were measured. Homocystein and hsCRP levels were measured in serum and compared between the groups. Flow-mediated dilation was assessed using brachial artery duplex ultrasonography. Results: Plasma total cholesterol, LDL-cholesterol, triglyceride levels were significantly higher in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Plasma HDL-cholesterol levels were significantly lower in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Serum homocystein levels and hsCRP levels were found significantly higher in Maras powder and cigarette smokers group compared to the nontobacco user group (p<0.001) whereas there was no significant difference between the Maras powder and cigarette smokers group. Baseline brachial artery diameter, endothelium-dependent FMD induced by reactive hyperemia, and endothelium-independent dilation induced by administration of sublingual nitroglycerin were measured. Brachial artery endothelium-dependent FMD was found significantly lover in Maras powder (5,73 ± 2,99) and cigarette smokers (6,55 ± 3,50 ) group compared to the nontobacco users (11,86 ± 4,61 )(p<0.001, p<0.001, respectively). Conclusions: Brachial artery FMD, a surrogate for endothelial dysfunction, was significantly impaired in smokeless tobacco users and cigarette smokers compared with nonusers of tobacco.