Smoking and smokeless tobacco consumption: Possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in Bangladesh

Objectives: To determine the risk of coronary heart disease (CHD) associated with various types of tobacco consumption among young patients aged 20-49 years attending a tertiary care cardiac hospital in Bangladesh. Study design: Case-control study. Methods: The study was undertaken at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. The study population comprised 69 cases with CHD and 138 controls without CHD from the emergency department of NICVD. Quantitative interviews were performed. Results: Most of the cases (79.7%) were either current or past consumers of some form of tobacco, compared with less than half of the controls (46.4%). The increased risk of CHD was approximately four fold in ever smokers [adjusted odds ratio (OR)4.0, 95% confidence interval (0) 1.7-9.5] and cases who had ever used smokeless tobacco (adjusted OR 4.0, 95% CI 2.0-8.1). Smokeless tobacco consumption was strongly associated with CHD after adjustment for smoking and other confounders. Conclusion: This study found evidence for an association between various types of tobacco consumption and CHD, particularly for bidi smoking and different types of smokeless tobacco consumption. Policies should be made and implemented to combat bidi smoking and smokeless tobacco consumption, as well as cigarette smoking. (C) 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.