title: Smokeless tobacco (snus) and risk of heart failure: results from two Swedish cohorts.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden. gabriel.arefalk@medsci.uu.se
authors.forename: Gabriel
authors.initials: G
authors.lastname: Arefalk
authors.forename: Maria-Pia
authors.initials: MP
authors.lastname: Hergens
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.forename: Olof
authors.initials: O
authors.lastname: Nyrén
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects*