title: Smokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men.
abstract: OBJECTIVE
  To explore whether the use of snuff affects the risk of myocardial infarction (MI).
  
  
  BACKGROUND
  Snuff and other forms of smokeless tobacco are widely used in some populations. Possible health hazards associated with the use of smokeless tobacco remain controversial.
  
  
  METHODS
  In a population-based study within the framework of the Northern Sweden center of the World Health Organization Multinational Monitoring of Trend and Determinants in Cardiovascular Disease (WHO MONICA) Project, tobacco habits were compared in 25- to 64-year-old men with first-time fatal or nonfatal MI and referent subjects matched for age and place of living (687 cases, 687 referents).
  
  
  RESULTS
  The unadjusted odds ratio (OR) for MI in regular cigarette smokers as compared with men who never used tobacco was 3.65 (95% confidence interval [CI] 2.67 to 4.99). When nonsmoking regular snuff dippers were compared with never-users of tobacco, the unadjusted OR was 0.96 (0.65 to 1.41). After adjustment for multiple cardiovascular risk factors, the OR was 3.53 (95% CI 2.48 to 5.03) for regular smoking and 0.58 (95% CI 0.35 to 0.94) for regular snuff dipping. Restricting the analyses to fatal cases of myocardial (including sudden death) showed a tendency towards increased risk among snuff dippers 1.50 (95% CI 0.45 to 5.03).
  
  
  CONCLUSIONS
  The risk of MI is not increased in snuff dippers. Nicotine is probably not an important contributor to ischemic heart disease in smokers. A possible small or modest detrimental effect of snuff dipping on the risk for sudden death could not be excluded in this study due to a limited number of fatal cases.
authors.affiliation: Department of Medicine at Luleå-Boden Hospital, Umeå, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Huhtasaari
authors.forename: V
authors.initials: V
authors.lastname: Lundberg
authors.forename: M
authors.initials: M
authors.lastname: Eliasson
authors.forename: U
authors.initials: U
authors.lastname: Janlert
authors.forename: K
authors.initials: K
authors.lastname: Asplund
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010947:Plants, Toxic; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*