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Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival

Hansson, J.; Galanti, M. R.; Hergens, M. -P.; Fredlund, P.; Ahlbom, A.; Alfredsson, L.; Bellocco, R.; Engström, Gunnar LU ; Eriksson, M. and Hallqvist, J., et al. (2014) In Journal of Internal Medicine 276(1). p.87-95
Abstract
Background. Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear. Objective. The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes. Methods. Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods,... (More)
Background. Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear. Objective. The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes. Methods. Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods, respectively. Results. No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92-1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28-day case fatality was 1.42 (95% CI 0.99-2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow-up period was 1.32 (95% CI 1.08-1.61). Conclusion. Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms. (Less)
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Contribution to journal
publication status
published
subject
keywords
smokeless tobacco, snus, stroke
in
Journal of Internal Medicine
volume
276
issue
1
pages
87 - 95
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • wos:000337787500011
  • scopus:84906093667
ISSN
1365-2796
DOI
10.1111/joim.12219
language
English
LU publication?
yes
id
70dadeef-14bb-4a1c-91fd-e097aa36b000 (old id 4609477)
date added to LUP
2014-09-01 07:41:27
date last changed
2017-08-27 04:49:54
@article{70dadeef-14bb-4a1c-91fd-e097aa36b000,
  abstract     = {Background. Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear. Objective. The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes. Methods. Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods, respectively. Results. No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92-1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28-day case fatality was 1.42 (95% CI 0.99-2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow-up period was 1.32 (95% CI 1.08-1.61). Conclusion. Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms.},
  author       = {Hansson, J. and Galanti, M. R. and Hergens, M. -P. and Fredlund, P. and Ahlbom, A. and Alfredsson, L. and Bellocco, R. and Engström, Gunnar and Eriksson, M. and Hallqvist, J. and Hedblad, Bo and Jansson, J. -H. and Pedersen, N. L. and Trolle Lagerros, Y. and Östergren, Per-Olof and Magnusson, C.},
  issn         = {1365-2796},
  keyword      = {smokeless tobacco,snus,stroke},
  language     = {eng},
  number       = {1},
  pages        = {87--95},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival},
  url          = {http://dx.doi.org/10.1111/joim.12219},
  volume       = {276},
  year         = {2014},
}