Smokeless tobacco (snus) and risk of heart failure: results from two Swedish cohorts

Arefalk, Gabriel; Hergens, Maria-Pia; Ingelsson, Erik; Ärnlöv, Johan; Michaëlsson, Karl; Lind, Lars; W, Ye; Nyrén, Olof; Lambe, Mats; Sundström, Johan

doi:10.1177/1741826711420003

Cited by 44 publications

(38 citation statements)

References 26 publications

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“…Another recent relevant publication [25] investigated the relationship between snus and risk of heart failure based on results from two Swedish cohorts. One was the Construction Workers Study, where an analysis in never smokers including 75 cases in current snus users reported a marginally significant RR of 1.28 (95% CI 1.00-1.64) after adjustment for age, BMI, region and AMI before baseline.…”

Section: Resultsmentioning

confidence: 99%

Epidemiological evidence relating snus to health – an updated review based on recent publications

2013

Harm Reduct J

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An earlier review summarized evidence relating use of snus (Swedish-type moist snuff) to health and to initiation and cessation of smoking. This update considers the effect recent publications on snus use and health have on the overall evidence. The additional evidence extends the list of neoplastic conditions unassociated with snus use (oropharynx, oesophagus, stomach, lung) to include colorectal cancer and acoustic neuroma, and further undermines the weakly-based argument that snus use increases the risk of pancreatic cancer, although there is a report of poorer cancer survival in users. It remains undemonstrated that “snuff-dipper’s lesion” increases risk of oral cancer, and recent publications add to the evidence that snus use has no effect on periodontitis or dental caries. Although onset of acute myocardial infarction is not adversely associated with snus use, there is some evidence of an association with reduced survival. Whether this is a direct effect of snus use or a result of confounding by socioeconomic status or other factors requires further investigation, as does a report of an increased risk of heart failure in snus users. Even if some adverse health effects of snus use do exist, it remains clear that they are far less than those of smoking.

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Section: Resultsmentioning

confidence: 99%

Epidemiological evidence relating snus to health – an updated review based on recent publications

2013

Harm Reduct J

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“…This should serve as one piece in the puzzle where most prospective studies fail to find any excess risk of myocardial infarction incidence among snus users [1,[7][8][9]41,42], including a recent pooled analysis of eight prospective observational studies [43]. However, as some studies have indicated an increased risk for fatal myocardial infarction [44][45][46], stroke [46,47] and heart failure [48] for snus users, the need for further studies on snus and health remains.…”

Section: Discussionmentioning

confidence: 98%

Snus use and cardiovascular risk factors in the general population: the HUNT3 study

et al. 2013

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“…In a previous study, snus use was associated with an increased risk for incident heart failure, both of ischemic and nonischemic origin. 22 In the present study, because echocardiography was performed during the hospital stay and not at baseline 2 months after the MI, any differences in left ventricular function between post-MI snus quitters and post-MI continuing snus users at baseline or during follow-up are unknown.…”

Section: Circulationmentioning

confidence: 89%

“…[19][20][21] Furthermore, snus use may be associated with a higher risk of heart failure, an important MI sequel. 22 No previous study has addressed the question of whether snus users who have an MI benefit from discontinuation of snus use.…”

Section: Clinical Perspective On P 332mentioning

confidence: 99%

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

et al. 2014

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Background-Given the indications of increased risk for fatal myocardial infarction (MI) in people who use snus, a moist smokeless tobacco product, we hypothesized that discontinuation of snus use after an MI would reduce mortality risk. Methods and Results-All patients who were admitted to coronary care units for an MI in Sweden between 2005 and 2009 and were <75 years of age underwent a structured examination 2 months after discharge (the baseline of the present study).We investigated the risk of mortality in post-MI snus quitters (n=675) relative to post-MI continuing snus users (n=1799) using Cox proportional hazards analyses. During follow-up (mean 2.1 years), 83 participants died. The mortality rate was 9.7 (95% confidence interval, 5.7-16.3) per 1000 person-years at risk in post-MI snus quitters and 18.7 (14.8-23.6) per 1000 person-years at risk in post-MI continuing snus users. After adjustment for age and sex, post-MI snus quitters had half the mortality risk of post-MI continuing snus users (hazard ratio, 0.51; 95% confidence interval, 0.29-0.91). In a multivariable-adjusted model, the hazard ratio was 0.57 (95% confidence interval, 0.32-1.02). The corresponding estimate for people who quit smoking after MI versus post-MI continuing smokers was 0.54 (95% confidence interval, 0.42-0.69). Conclusions-In this study, discontinuation of snus use after an MI was associated with a nearly halved mortality risk, similar to the benefit associated with smoking cessation. These observations suggest that the use of snus after MI should be discouraged. (Circulation. 2014;130:325-332.)

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Smokeless tobacco (snus) and risk of heart failure: results from two Swedish cohorts

Abstract: Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.

Cited by 44 publications

References 26 publications

Epidemiological evidence relating snus to health – an updated review based on recent publications

Epidemiological evidence relating snus to health – an updated review based on recent publications

Snus use and cardiovascular risk factors in the general population: the HUNT3 study

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

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