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Snus ( S wedish 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, G. +8 more·2014·Journal of Internal Medicine
DOI 10.1111/joim.12219
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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 ( HR s) with 95% confidence intervals ( CI s) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and K aplan– M eier 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.

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  • In a pooled analysis, there is no association between using snus and risk of any stroke subtypes (HR = 1.04, 95% CI: 0.92-1.17); among snus users who had experienced a stroke, there are increased odds of 28-day case fatality (OR = 1.42; 95% CI: 0.99-2.04) and risk of death during follow-up (HR = 1.32; 95% CI: 1.08-1.61).

    “no associations between using snus and the risk of any stroke subtypes (HR = 1.04, 95% CI: 0.92-1.17).Among snus who had experienced a stroke, there were increased odds of 28-day case fatality (odds ratio (OR) = 1.42; 95% CI: 0.99-2.04)and the risk of death during the follow-up period (HR = 1.32; 95% CI: 1.08-1.61)(Hansson et al. 2014).”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Hansson et al. 2014

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Authors
Hansson, J., Galanti, M. R., Hergens, M. ‐., Fredlund, P., Ahlbom, A., Alfredsson, L., Bellocco, R., Engström, G., Eriksson, M., Hallqvist, J., Hedblad, B., Jansson, J. ‐., Pedersen, N. L., Trolle Lagerros, Y., Östergren, P. ‐., & Magnusson, C.
Venue
Journal of Internal Medicine
Publisher
Wiley
Published
2014-03-29
Volume
276
Issue
1
Pages
87-95
ISSN
  • 0954-6820
  • 1365-2796
DOI
10.1111/joim.12219
Cited by
57
References
2
Language
en
Licence
Funders
  • Stockholm County Council
  • Swedish Research Council (2007-3185)
  • National Institute of Public Health (2008/188)
  • Swedish Council for Working Life and Social Research (2010-0546)

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