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

• Published in: European journal of preventive cardiology 2012-10, Vol.19 (5), p.1120-1127
• Main Authors: Arefalk, Gabriel, Hergens, Maria-Pia, Ingelsson, Erik, Ärnlöv, Johan, Michaëlsson, Karl, Lind, Lars, Ye, Weimin, Nyrén, Olof, Lambe, Mats, Sundström, Johan
• Format: Article
• Language: English
• Subjects: Adult; Confidence Intervals; Female; Follow-Up Studies; Heart Failure - chemically induced; Heart Failure - epidemiology; Humans; Incidence; Male; Medicin och hälsovetenskap; Middle Aged; Proportional Hazards Models; Prospective Studies; Risk Assessment - methods; Risk Factors; Sweden - epidemiology; Time Factors; Tobacco, Smokeless - adverse effects
• ISSN: 2047-4873; 2047-4881; 2047-4881
• DOI: 10.1177/1741826711420003

Background: Oral moist snuff (snus) is discussed as a safer alternative to smoking, and its use is increasing. Based on its documented effect on blood pressure, we hypothesized that use of snus increases the risk of heart failure. Design: Two independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers. Methods: Cox proportional hazards models were used to investigate possible associations of snus use with risk of a first hospitalization for heart failure. Results: In ULSAM, 95 men were hospitalized for heart failure, during a median follow up of 8.9 years. In a model adjusted for established risk factors including past and present smoking exposure, current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03⊟4.22] relative to non-use. Snus use was particularly associated with risk of non-ischaemic heart failure (HR 2.55, 95% CI 1.12⊟5.82). In CWC, 545 men were hospitalized for heart failure, during a median follow up of 18 years. In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00⊟1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97⊟1.68) relative to never tobacco use. Conclusion: Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.