title: Non-Smoking Tobacco Affects Endothelial Function in Healthy Men in One of the Largest Health Studies Ever Performed; The Nord-Trøndelag Health Study in Norway; HUNT3.
abstract: BACKGROUND
  Oral tobacco (snuff) is taking a large market share in Scandinavia, especially with young users. However, long-term health effects are unknown. Small studies show association between snuff and reduced endothelial function, representing an early stage of vascular injury that often precedes manifest cardiovascular disease by several years. We therefore determined the associations between snuff and endothelial function in a large sample of healthy Norwegian men.
  
  
  METHODS
  In the Fitness substudy of the Nord-Trøndelag Health Study (HUNT3), endothelial function was measured by flow-mediated dilation (FMD). Aerobic fitness was measured by peak oxygen uptake (VO2peak). A cross-sectional design including 1 592 self-reported healthy men compared these observations with records of present tobacco use, standard cardiovascular risk factors, and socioeconomic status, using general linear models.
  
  
  RESULTS
  FMD was lower in snuff users (FMD: 4.12%, 3.63, 4.61) compared to non-users (FMD: 4.52%, 4.27, 4.78) after adjustment for age (difference: -0.57%, -1.12, -0.01). After further adjustment for potential confounders, FMD still tended to be lower in snuff users than in non-users (difference: -0.53%, -1.09, 0.02). This difference was even more pronounced in the inactive snuff users (-0.83%, -1.59, -0.06) and in the low fit snuff users (-0.74%, CI -0.55, 0.079).
  
  
  CONCLUSIONS
  Oral tobacco is associated with a tendency towards reduced endothelial function, indicating vascular changes that precede cardiovascular disease. The strongest associations were found in men with low physical activity or reduced aerobic fitness.
authors.affiliation: K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Eli-Anne
authors.identifier: http://orcid.org/0000-0001-8472-3916
authors.initials: EA
authors.lastname: Skaug
authors.affiliation: K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Nes
authors.affiliation: K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Stian Thoresen
authors.initials: ST
authors.lastname: Aspenes
authors.affiliation: K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Cardiology, St. Olav's Hospital, Trondheim, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Ellingsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000209:etiology; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012307:Risk Factors; D057566:Self Report; D012907:Smoking; D014030:Tobacco, Smokeless; D018608:Ultrasonography, Doppler
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL