Abstract
BackgroundCigarette smoking is a well-known risk factor for cardiovascular disease (CVD), but whether smokeless tobacco such as snuff is associated with the risk of CVD is still unclear. We investigated the association of the use of Swedish oral moist snuff (snus) with a broad range of CVDs and CVD mortality.MethodsWe used data from a population-based cohort of 41,162 Swedish adults with a mean baseline age of 70 (56–94) years who completed questionnaires regarding snus use and other lifestyle habits and health characteristics. Participants were followed up for incident cardiovascular outcomes and death over 8 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios (HR) were estimated by Cox proportional hazards regression. We conducted analyses among all subjects as well as among never smokers to reduce residual confounding from smoking.ResultsAfter adjustment for smoking and other confounders, snus use was not associated with myocardial infarction, heart failure, atrial fibrillation, aortic valve stenosis, abdominal aortic aneurysm, stroke, or CVD mortality. However, in never smokers, snus use was associated with a statistically significant increased risk of total and ischemic stroke (HRs [95% confidence intervals] = 1.52 [1.01–2.30] and 1.63 [1.05–2.54], respectively) and non-significantly positively associated with some other CVDs.ConclusionsIn this middle-aged and elderly Swedish population, current Swedish snus use was not associated with the risk of major heart and valvular diseases, abdominal aortic aneurysm, or CVD mortality in the entire study population, but was linked to an increased risk of stroke in never smokers.
Highlights
Cigarette smoking is a well-known risk factor for cardiovascular disease (CVD), but whether smokeless tobacco such as snuff is associated with the risk of cardiovascular diseases (CVDs) is still unclear
In age- and sex-adjusted analysis, current snus use was associated with increased risk of atrial fibrillation (AF) and abdominal aortic aneurysm (AAA) compared with non-use, but these associations did not remain after adjustment for cigarette smoking and other risk factors (Table 2)
There was no association between snus use and the other CVDs
Summary
Cigarette smoking is a well-known risk factor for cardiovascular disease (CVD), but whether smokeless tobacco such as snuff is associated with the risk of CVD is still unclear. We investigated the association of the use of Swedish oral moist snuff (snus) with a broad range of CVDs and CVD mortality. Compared to the late 1980s, there was an increase in snus consumption in Sweden, accompanied by a considerable decline in prevalence of cigarette smoking [12]. Despite the absence of harmful combustion products, the amount of nicotine in smokeless tobacco is comparable to that in cigarettes and the peak blood concentration of nicotine in users is similar to those observed in cigarette smokers [13, 14]. The long-term effect of moist snuff on the cardiovascular system has not been thoroughly studied and results remain inconsistent
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