Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals
Abstract Background 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 CVD...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-021-01979-6 |
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| author | Olga E. Titova John A. Baron Karl Michaëlsson Susanna C. Larsson |
| author_facet | Olga E. Titova John A. Baron Karl Michaëlsson Susanna C. Larsson |
| author_sort | Olga E. Titova |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-21T12:20:14Z |
| format | Article |
| id | doaj.art-51ecd95c791b4ad091107f1f6647270e |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-21T12:20:14Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-51ecd95c791b4ad091107f1f6647270e2022-12-21T19:04:19ZengBMCBMC Medicine1741-70152021-05-0119111010.1186/s12916-021-01979-6Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individualsOlga E. Titova0John A. Baron1Karl Michaëlsson2Susanna C. Larsson3Department of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala UniversityDepartment of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala UniversityDepartment of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala UniversityDepartment of Surgical Sciences, Unit of Medical Epidemiology, The EpiHub, Uppsala UniversityAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12916-021-01979-6Cardiovascular diseaseSnusSnuffSmokeless tobaccoMortality |
| spellingShingle | Olga E. Titova John A. Baron Karl Michaëlsson Susanna C. Larsson Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals BMC Medicine Cardiovascular disease Snus Snuff Smokeless tobacco Mortality |
| title | Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals |
| title_full | Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals |
| title_fullStr | Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals |
| title_full_unstemmed | Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals |
| title_short | Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals |
| title_sort | swedish snuff snus and risk of cardiovascular disease and mortality prospective cohort study of middle aged and older individuals |
| topic | Cardiovascular disease Snus Snuff Smokeless tobacco Mortality |
| url | https://doi.org/10.1186/s12916-021-01979-6 |
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