Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals

BMC Medicine

Olga E. Titova¹  Karl Michaëlsson¹  John A. Baron²  Susanna C. Larsson³ 

[1] Department of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala University, Dag Hammarskjölds väg 14 B, 75185, Uppsala, Sweden;Department of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala University, Dag Hammarskjölds väg 14 B, 75185, Uppsala, Sweden;Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA;Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;Department of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala University, Dag Hammarskjölds väg 14 B, 75185, Uppsala, Sweden;Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;

关键词: Cardiovascular disease;    Snus;    Snuff;    Smokeless tobacco;    Mortality;   

DOI  :  10.1186/s12916-021-01979-6

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY