Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies.
The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.
Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. jenny.hansson@ki.se
Jenny
J
Hansson
Maria Rosaria
MR
Galanti
Maria-Pia
MP
Hergens
Peeter
P
Fredlund
Anders
A
Ahlbom
Lars
L
Alfredsson
Rino
R
Bellocco
Marie
M
Eriksson
Johan
J
Hallqvist
Bo
B
Hedblad
Jan-Håkan
JH
Jansson
Peter
P
Nilsson
Nancy
N
Pedersen
Ylva
Y
Trolle Lagerros
Per-Olof
PO
Ostergren
Cecilia
C
Magnusson
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*