Swedish snuff and incidence of cardiovascular disease. A population-based cohort study

Abstract

BackgroundThe relationship between smoking and an increased incidence of cardiovascular diseases is well known. Whether smokeless tobacco (snuff) is related to myocardial infarction (MI) or stroke is still controversial. Aim of this study was to explore whether snuff users have an increased incidence of MI or stroke.MethodsA total of 16 754 women and 10 473 men (aged 45–73 years), without history of cardiovascular disease (CVD), belonging to the population-based "Malmö Diet and Cancer" study were examined. Incidence of MI and stroke were monitored over 10.3 years.ResultsSnuff was used by 737 (7.0%) men and 75 (0.4%) women, respectively. Among men, snuff was significantly associated with low occupation level, single civil status, high BMI and with current and former smoking. In women, snuff was associated with lower systolic blood pressure. A total of 964 individuals (3.5%), i.e.544 men (5.3%) and 420 (2.5%) women suffered a MI during the follow-up period. The corresponding numbers of incident stroke cases were 1048, i.e. 553 men (5.3%) and 495 (3.0%) women, respectively. Snuff was not associated with any statistically significant increased risk of MI or stroke in men or women. The relative risks (RR) in male snuff users compared to non-users were 1.05 (95% confidence interval (CI): 0.8–1.4, p = 0.740) for incident MI and 0.97 (0.7–1.4, p = 0.878) for stroke, after taking age and potential confounders into account. In women none of the 420 (2.5%) women who were snuff users had a MI and only one suffered a stroke during the follow-up.ConclusionSeveral life-style risk factors were more prevalent in snuff-users than in non-users. However, the present study does not support any relationship between snuff and incidence of cardiovascular disease in men.

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

“…Cardiovascular effects of smokeless tobacco have been less studied, but there are reports on acute autonomic and hemodynamic effects such as endothelial dysfunction 5,6 and increased blood pressure, heart rate, and blood levels of adrenaline. 7,8 No increased risk of MI incidence has been observed in previous studies, [9][10][11][12][13][14][15][16] although 2 meta-analyses have reported a seemingly increased risk for fatal MI, 17,18 which suggests that snus use may predispose to arrhythmic or other serious complications of MI. Nicotine exposure has also been associated with increased vulnerability for ventricular fibrillation after MI in animal studies.…”

“…Apart from 1 exception based primarily on tobacco chewers, 26 no increase in risk of MI incidence has been observed. [9][10][11][12][13][14][15][16] The risk of MI mortality has been elevated in some studies, 15,27 which suggests an increased case-fatality rate, with a 13% increased risk in a 2009 meta-analysis 17 and a 28% increased risk in a 2012 pooled meta-analysis. 18 In a review and meta-analysis, smoking cessation was associated with a 36% reduction in risk of all-cause mortality among patients with coronary heart disease.…”

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

“…Overall, our results do not indicate any strong associations between snus use and at least the CVD risk factors included here. 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.…”

Socio-demographic and behavioural determinants of body mass index among an adult population in rural Northern Ghana: the AWI-Gen study

“…This negative association may be attributed to reduced caloric intake due to a central effect of smoking, impaired smell or taste, a change in food preference, or a direct metabolic effect on the absorption or storage of calories, or an increase in energy expenditure [48]. The association between smokeless tobacco use and increased risk of cardiometabolic-related morbidities and mortalities has been well characterized [49–51]. However, in our study, smokeless tobacco use was associated with a lower BMI in women.…”