HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Related articles in AJPH Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bolinder, G Articles by de Faire, U Search for Related Content PubMed PubMed Citation Articles by Bolinder, G Articles by de Faire, U

Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers.

G Bolinder, L Alfredsson, A Englund and U de Faire

Department of Medicine, Karolinska Hospital, Stockholm, Sweden.

OBJECTIVES. Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nicotine levels similar to those caused by cigarette smoking. METHODS. Male Swedish construction industry employees (n = 135,036) who attended a health examination were followed by studying cause-specific mortality during a 12-year period. The study population comprised 6297 smokeless tobacco users, 14,983 smokers of fewer than 15 cigarettes per day, 13,518 smokers of 15 or more cigarettes per day, 17,437 ex-smokers, 50,255 "other" tobacco users, and 32,546 nonusers. RESULTS. The age-adjusted relative risk of dying from cardiovascular disease was 1.4 for smokeless tobacco users and 1.9 for smokers of 15 or more cigarettes per day, compared with nonusers. Among men aged 35 through 54 years at the start of follow-up, the relative risk was 2.1 for smokeless tobacco users and 3.2 for smokers. When data were adjusted for body mass index, blood pressure, and history of heart symptoms, the results were essentially unchanged. Cancer mortality was not raised in smokeless tobacco users. CONCLUSIONS. Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Although the risk is lower for smokeless tobacco users than for smokers, the excess risk gives cause for preventive actions.

Related articles in AJPH:

Excess mortality in smokeless tobacco users not meaningful.

B Rodu and P Cole
AJPH 1995 85: 118-119. [PDF]  

This article has been cited by other articles:

				B. J. Apelberg, G. Onicescu, E. Avila-Tang, and J. M. Samet Estimating the Risks and Benefits of Nicotine Replacement Therapy for Smoking Cessation in the United States Am J Public Health, February 1, 2010; 100(2): 341 - 348. [Abstract] [Full Text] [PDF]

				D. K. Hatsukami, K. Hanson, A. Briggs, M. Parascandola, J. M. Genkinger, R. O'Connor, and P. G. Shields Clinical Trials Methods for Evaluation of Potential Reduced Exposure Products Cancer Epidemiol. Biomarkers Prev., December 1, 2009; 18(12): 3143 - 3195. [Abstract] [Full Text] [PDF]

				J. L. Studts, J. L. Burris, D. K. Kearns, C. T. Worth, and C. L. Sorrell "Providers Practice Prevention": Promoting Dental Hygienists' Use of Evidence-Based Treatment of Tobacco Use and Dependence J Dent Educ., September 1, 2009; 73(9): 1069 - 1082. [Abstract] [Full Text] [PDF]

				H R Alpert, H Koh, and G N Connolly Free nicotine content and strategic marketing of moist snuff tobacco products in the United States: 2000-2006 Tob. Control, October 1, 2008; 17(5): 332 - 338. [Abstract] [Full Text] [PDF]

				B. Haglund, M. Eliasson, M. Stenbeck, and M. Rosen Is moist snuff use associated with excess risk of IHD or stroke? A longitudinal follow-up of snuff users in Sweden Scand J Public Health, December 1, 2007; 35(6): 618 - 622. [Abstract] [PDF]

				M. Lindstrom Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden Tob. Control, December 1, 2007; 16(6): 410 - 416. [Abstract] [Full Text] [PDF]

				P. N Lee Circulatory disease and smokeless tobacco in Western populations: a review of the evidence Int. J. Epidemiol., August 1, 2007; 36(4): 789 - 804. [Abstract] [Full Text] [PDF]

				A. Halling, A. Halling, and L. Unell General health and tobacco habits among middle-aged Swedes Eur J Public Health, April 1, 2007; 17(2): 151 - 154. [Abstract] [Full Text] [PDF]

				S J. Henley, C. J Connell, P. Richter, C. Husten, T. Pechacek, E. E Calle, and M. J Thun Tobacco-related disease mortality among men who switched from cigarettes to spit tobacco Tob. Control, February 1, 2007; 16(1): 22 - 28. [Abstract] [Full Text] [PDF]

				J. M. Rippe, T. J. Angelopoulos, and L. Zukley The Rationale for Intervention to Reduce the Risk of Coronary Heart Disease American Journal of Lifestyle Medicine, January 1, 2007; 1(1): 10 - 19. [Abstract] [PDF]

				M. Norberg, H. Stenlund, B. Lindahl, K. Boman, and L. Weinehall Contribution of Swedish moist snuff to the metabolic syndrome: A wolf in sheep's clothing? Scand J Public Health, December 1, 2006; 34(6): 576 - 583. [Abstract] [PDF]

				G. Bostrom Chapter 9: Habits of life and health Scand J Public Health, June 1, 2006; 34(67_suppl): 199 - 228. [PDF]

				D. E. Nelson, P. Mowery, S. Tomar, S. Marcus, G. Giovino, and L. Zhao Trends in Smokeless Tobacco Use Among Adults and Adolescents in the United States Am J Public Health, May 1, 2006; 96(5): 897 - 905. [Abstract] [Full Text] [PDF]

				P. C Gupta, M. S Pednekar, D. Parkin, and R Sankaranarayanan Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study Int. J. Epidemiol., December 1, 2005; 34(6): 1395 - 1402. [Abstract] [Full Text] [PDF]

				B. Stegmayr, M. Eliasson, and B. Rodu The Decline of Smoking in Northern Sweden Scand J Public Health, August 1, 2005; 33(4): 321 - 324. [Abstract] [PDF]

				R. Wolk, A. S.M. Shamsuzzaman, A. Svatikova, C. M. Huyber, C. Huck, K. Narkiewicz, and V. K. Somers Hemodynamic and autonomic effects of smokeless tobacco in healthy young men J. Am. Coll. Cardiol., March 15, 2005; 45(6): 910 - 914. [Abstract] [Full Text] [PDF]

				R. Gupta, H. Gurm, and J. R. Bartholomew Smokeless Tobacco and Cardiovascular Risk Arch Intern Med, September 27, 2004; 164(17): 1845 - 1849. [Abstract] [Full Text] [PDF]

				D. K. Hatsukami, C. Lemmonds, Y. Zhang, S. E. Murphy, C. Le, S. G. Carmella, and S. S. Hecht Evaluation of Carcinogen Exposure in People Who Used "Reduced Exposure" Tobacco Products J Natl Cancer Inst, June 2, 2004; 96(11): 844 - 852. [Abstract] [Full Text] [PDF]

				J. A. Ambrose and R. S. Barua The pathophysiology of cigarette smoking and cardiovascular disease: An update J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1731 - 1737. [Abstract] [Full Text] [PDF]

				J Foulds, L Ramstrom, M Burke, and K Fagerstrom Effect of smokeless tobacco (snus) on smoking and public health in Sweden Tob. Control, December 1, 2003; 12(4): 349 - 359. [Abstract] [Full Text] [PDF]

				B. Lindahl, B. Stegmayr, I. Johansson, L. Weinehall, and G. Hallmans Trends in lifestyle 1986 - 99 in a 25- to 64-year-old population of the Northern Sweden MONICA project Scand J Public Health, November 1, 2003; 31(61_suppl): 31 - 37. [Abstract] [PDF]

				K. Asplund, S. Nasic, U. Janlert, and B. Stegmayr Smokeless Tobacco as a Possible Risk Factor for Stroke in Men: A Nested Case-Control Study Stroke, July 1, 2003; 34(7): 1754 - 1759. [Abstract] [Full Text] [PDF]

				J A Critchley and B Unal Health effects associated with smokeless tobacco: a systematic review Thorax, May 1, 2003; 58(5): 435 - 443. [Abstract] [Full Text] [PDF]

				N. A. Accortt, J. W. Waterbor, C. Beall, and G. Howard Chronic Disease Mortality in a Cohort of Smokeless Tobacco Users Am. J. Epidemiol., October 15, 2002; 156(8): 730 - 737. [Abstract] [Full Text] [PDF]

				R. S. Barua, J. A. Ambrose, L.-J. Eales-Reynolds, M. C. DeVoe, J. G. Zervas, and D. C. Saha Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: An in vivo and in vitro correlation J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1758 - 1763. [Abstract] [Full Text] [PDF]

				B. Howard-Pitney and M. A. Winkleby Chewing Tobacco: Who Uses and Who Quits? Findings From NHANES III, 1988-1994 Am J Public Health, February 1, 2002; 92(2): 250 - 256. [Abstract] [Full Text] [PDF]

				M. M Walsh, J. Ellison, J. F Hilton, M. Chesney, and V. L Ernster Spit (smokeless) tobacco use by high school baseball athletes in California Tob. Control, June 1, 2000; 9 (2009): ii32 - ii39. [Abstract] [Full Text] [PDF]

				F. Huhtasaari, V. Lundberg, M. Eliasson, U. Janlert, and K. Asplund Smokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1784 - 1790. [Abstract] [Full Text] [PDF]

				B. Eliasson, M.-R. Taskinen, and U. Smith Long-term Use of Nicotine Gum Is Associated With Hyperinsulinemia and Insulin Resistance Circulation, September 1, 1996; 94(5): 878 - 881. [Abstract] [Full Text]