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

• Published in: BMC medicine 2021-05, Vol.19 (1), p.111-111, Article 111
• Main Authors: Titova, Olga E, Baron, John A, Michaëlsson, Karl, Larsson, Susanna C
• Format: Article
• Language: English
• Subjects: Aged; Alcohol use; Aorta; Aortic aneurysms; Aortic valve; Beroendelära; Body mass index; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Cigarette smoking; Cigarettes; Cohort analysis; Complications and side effects; Confidence intervals; Congestive heart failure; Coronary artery disease; Diabetes; Educational attainment; Fibrillation; Health aspects; Health hazards; Health risks; Heart diseases; Heart failure; Heart valves; Hypertension; Hälsovetenskap; Ischemia; Kardiologi; Klinisk medicin; Medicin och hälsovetenskap; Middle age; Middle aged persons; Mortality; Myocardial infarction; Nicotine; Patient outcomes; Population; Population studies; Questionnaires; Rheumatic heart disease; Risk analysis; Risk factors; Smokeless tobacco; Smoking; Snuff; Snus; Statistical analysis; Stenosis; Stroke; Tobacco; Tobacco habit; Variables; Womens health
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-021-01979-6

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. We 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. After 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. In 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.