Objective To determine the association between smokeless tobacco (SLT) use and coronary heart disease (CHD) among non-smoking adults in Bangladesh.

Methods A case-control study of non-smoking Bangladeshi adults aged 40–75 years, was conducted in 2010. Incident cases of CHD were selected from two cardiac hospitals. Hospital controls were selected from outpatient departments of the same hospitals. Community controls were selected from neighbourhoods matched to CHD cases. Four community controls and one hospital control were matched to each case on age and gender.

Results The study enrolled 302 cases, 1208 community controls and 302 hospital controls. Forty percent of the study subjects were current users of or had used SLT in the past. Current use of SLT was similar among cases (33%), community controls (33%) and hospital controls (32%). Current use of SLT was not associated with increased risk of CHD when community controls were used (adjusted OR 0.87, 95% CI 0.63 to 1.19, p>0.05), or hospital controls were used (adjusted OR 1.00, 95% CI 0.63 to 1.60, p>0.05), or when both controls were combined (adjusted OR 1.00, 95% CI 0.74 to 1.34, p>0.05). Risk of CHD did not increase with use of individual type, frequency, duration and past use of SLT products.

Conclusion In this study, there was no statistically significant association between SLT use and CHD among non-smoking adults in Bangladesh. If the findings can be replicated in prospective studies, it may well be that strategic focus for reducing CHD in Bangladesh should be upon smoking control rather than on SLT.