August 21, 2009 - A meta-analysis of observational studies finds that people who use smokeless tobacco products like snus (a moist powder tobacco product) have a slightly higher risk of having a fatal heart attack or stroke.
PAPER: Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis, Paolo Boffetta, epidemiologist, Kurt Straif, epidemiologist, International Agency for Research on Cancer, Lyon, France, BMJ 2009;339:b3060, ABSTRACT.., FULL TEXT...
Over the last couple of decades, there has been an increase in the number of people in Europe and North America using smokeless tobacco. Most new users are aged under 40. According to the study, since these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is expected to increase.
Dr Paolo Boffetta led the research team that examined the results of 11 studies (mainly in men) carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke. In order to reduce partiality, variations in study plan and features were considered.
The results indicated there was a small increased risk of death from a heart attack or stroke among users of smokeless tobacco products compared with non-users. Smokeless tobacco was responsible for 0.5 percent of all heart attacks in the United States and 5.6 percent in Sweden. The products were also the cause of 1.7 percent of stroke deaths in the United States and 5.4 percent in Sweden.
The studies from both the United States and Sweden showed an increased risk of death from myocardial infarction and stroke. The inclusion of non-fatal myocardial infarction and non-fatal stroke lowered the summary risk estimates. Data on dose-response were limited but did not suggest a strong relation between risk of dying from either disease and frequency or duration of use of smokeless tobacco products.
In closing, the authors say that the degree of the excess risk was small, particularly for fatal myocardial infarction. However, the reliability of the results among studies and their strength with respect to study design and quality added to their credibility.
It was recommended that future research should aim to clarify the mechanisms of effect of smokeless tobacco products on deaths from cardiovascular disease and to elucidate whether a similar effect is present for non-fatal myocardial infarction and non-fatal stroke.
Reference: Increased Risk Of Heart Attack And Stroke With The Use Of Smokeless Tobacco Products, by Stephanie Brunner, Medical News Today, 8/19/2009.
A few related news briefs: Some facts for smokers to consider before considering smokeless tobacco..; Snus causes premature death..; Prolonged Use of SNUS (Swedish moist snuff) Increases Risk of Fatal Cardiovascular Disease(CVD) and Stroke..; News brief based on lead authors work: Smokeless Tobacco Can Also Increase Cancer Risk..; Snus does not save lives: quitting the use of tobacco does!.