Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Although the risk is lower for smokeless tobacco users than for smokers, the excess risk gives cause for preventive actions.

Background. The scientific evidence on cardiovascular risks associated with long-term use of snuff is limited and inconclusive. The use of this smokeless tobacco has increased in recent decades, and adverse health effects associated with snuff use could be of great public health concern.

Background: Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institutet have asked for more training in ECGinterpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECGinterpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity.

Health hazards associated with the use of smokeless tobacco were evaluated in a cross-sectional study of 97,586 Swedish construction workers undergoing health examinations in 1971-74. All users of smokeless tobacco only (5014 subjects) and all exclusive smokers of > or = 15 cigarettes daily (8823 subjects) were compared with all non-users of any tobacco (23,885). Both smokeless tobacco users and smokers showed higher prevalences of circulatory and respiratory disorders. Hypertension was most common in smokeless tobacco users. In the 45- to 56-years age group, the odds ratio for a diastolic blood pressure of > 90 mmHg was 1.8 (95% CI, 1.5-2.1), and for a systolic blood pressure > 160 mmHg, 1.7 (95% CI, 1.3-2.1). Smokers showed the lowest prevalence of hypertension. Disability pensions due to cardiovascular disease were nearly 50% more frequent in both smokeless tobacco users and smokers. These findings indicate that an increased cardiovascular risk is also associated with the use of smokeless tobacco.

Ambulatory 24-h blood pressure monitoring was conducted in 135 healthy, normotensive, middle-aged (35 to 60 years) men, with no antihypertensive medication, to study the influence of habitual smokeless tobacco use (n = 47) and smoking (n = 29) on diurnal blood pressure and heart rate. Comparisons were made with nonusers of tobacco (n = 59). Adjustments were made for differences in age, body mass index, waist-hip ratio, physical fitness, and alcohol intake. Daytime ambulatory heart rates were significantly (P < .05) elevated in both smokeless tobacco users and smokers compared with nonusers (69 +/- 14 and 74 +/- 13 beats/min, respectively, versus 63 +/- 12 beats/min). In subjects > or = 45 years old, ambulatory daytime diastolic blood pressures were significantly elevated, on average by 5 mm Hg, in both smokeless tobacco users and smokers (P < .001) compared with nonusers. Clinical measurements of heart rate and systolic blood pressure in smokers were significantly lower compared with the ambulatory mean values. Nighttime measurements showed only minor differences between the tobacco habit groups. The higher heart rates and blood pressures noted during the daytime in smokers and smokeless tobacco users were most likely due to the effects of nicotine. A strong positive relationship was found between cotinine (major nicotine metabolite) and blood pressure in smokeless tobacco users (systolic blood pressure, r = 0.48, P < .001; diastolic blood pressure, r = 0.41, P = .005), whereas an inverse relationship was found in smokers (systolic blood pressure, r = -0.12, P = .47; diastolic blood pressure, r = -0.03, P = .84), indicating additional and more complex influences on vascular tone in smokers than the influence of nicotine in smokeless tobacco users.