Swedish Moist Snuff and Myocardial Infarction Among Men

Hergens, Maria-Pia; Ahlbom, Anders; Andersson, Tomas; Pershagen, Göran

doi:10.1097/01.ede.0000147108.92895.ba

Cited by 91 publications

(122 citation statements)

References 30 publications

(28 reference statements)

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“…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.…”

Section: Clinical Perspective On P 332mentioning

confidence: 96%

“…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.…”

Section: Comparisons With Previous Studiesmentioning

confidence: 99%

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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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Section: Clinical Perspective On P 332mentioning

confidence: 96%

Section: Comparisons With Previous Studiesmentioning

confidence: 99%

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

et al. 2014

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“…Cardiovascular disease (CVD) is a major health risk from smoking, and accounts for 28 per cent of smoking-related deaths (SCENIHR, 2008). The relative risk of myocardial infarction for current smokers (vs. non-smokers) has been estimated to be 2.60-2.80 (Hergens et al, 2005;Wennberg et al, 2007), while for fatal myocardial infarction smokers have an OR over non-smokers of 3.6 (Hergens et al, 2005). With regard to snus use, no significant association with stroke has been found, but some Swedish studies have found significant but moderate effects for fatal, although not for nonfatal, myocardial infarction (OR=1.26; 1.27) (Boffetta & Straif, 2009).…”

Section: Perceptions Of Relative Risk Of Disease and Addiction From Cmentioning

confidence: 99%

Perceptions of relative risk of disease and addiction from cigarettes and snus.

Lund¹,

Scheffels²

2014

Psychology of Addictive Behaviors

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The public is largely unaware of the lower global risk associated with snus compared to that of cigarettes, but little is known of perceptions of relative risks for specific diseases. Inveterate, daily and non-daily smokers' perceptions of the relative snus/cigarette risk of cardiovascular disease, and of cancer of the lung, stomach, and oral cavity, and perceptions among smokers, snus users and dual users of the relative risk of nicotine addiction, was studied in a pooled sample from annual national surveys (2008)(2009)(2010)(2011) performed by Statistics Norway. The total sample included 2661 ever smokers and snus users aged 15-79 years old. 53 per cent were men, and the average age was 46.1 years.Compared to medical consensus, all smoker groups overestimated the relative risks of diseases from snus use, and inveterate smokers overestimated them significantly more than other groups. For all diseases except lung cancer, the majority of smokers thought snus users were running a higher or equal risk. For lung cancer, 22 per cent believed that snus use gave a higher or equal risk. Smokers, snus users and dual users tended to think that snus and cigarettes were equally addictive products, while a somewhat higher proportion of those who had quit both products thought that cigarettes were more addictive. Increased knowledge of the relative health risks might give smokers an incitement to switch to snus, and prompt current dual users to stop smoking completely. Awareness could be improved by tailoring information at targeted groups, for example via the health care system.

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“…A number of population-based studies have evaluated the risk for nonfatal and fatal coronary heart disease events, such as MI and sudden death in ST users ( 44 Similarly, Hergens et al 37 found no increase in risk for nonfatal MI or fatal MI among current snuff users living in northern Sweden. Two other case-control studies in Sweden have confirmed these latter findings.…”

Section: Myocardial Infarctionmentioning

confidence: 99%

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Benowitz²,

et al. 2010

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on behalf of the American Heart Association Council on Cardiovascular Nursing V arious forms of smokeless tobacco (ST) products (snuff, chewing tobacco) are used by individuals of all ages. Over the past several years, US tobacco companies have expanded marketing and promotion of ST products. A major aim of this statement is to review and summarize the scientific evidence regarding ST product use and the potential cardiovascular risks associated with ST product use that can be used to inform policy related to tobacco control and strategies related to tobacco harm reduction. A specific policy question is whether ST products should be recommended to smokers instead of cigarettes to reduce the morbidity and mortality associated with smoking and/or as an approach to enhance smoking cessation. Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy. Based on the findings reviewed in this statement, clinicians should continue to discourage use of all tobacco products and emphasize prevention of smoking initiation and smoking cessation as primary goals for tobacco control.In the United States, various forms of ST products (snuff, chewing tobacco) are used by individuals of all ages, including adolescents and young adults.

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Swedish Moist Snuff and Myocardial Infarction Among Men

Abstract: The hypothesis that smokeless tobacco increases the risk for myocardial infarction is not supported in the present study.

Cited by 91 publications

References 30 publications

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

Perceptions of relative risk of disease and addiction from cigarettes and snus.

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

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