Long-term use of Swedish moist snuff and the risk of myocardial infarction amongst men. [Erratum appears in J Intern Med. 2007;262(5):590]

Institute of Environmental Medicine, Karolinska Institutet, and Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Journal of Internal Medicine (Impact Factor: 6.06). 09/2007; 262(3):351-9. DOI: 10.1111/j.1365-2796.2007.01816.x
Source: PubMed


The scientific evidence on cardiovascular risks associated with long-term use of snuff is limited and inconclusive. The use of this smokeless tobacco has increased in recent decades, and adverse health effects associated with snuff use could be of great public health concern.
We aimed to study whether long-term use of snuff affects the risk of myocardial infarction.
Between 1978 and 1993 all construction workers in Sweden were offered repeated health check-ups by the Swedish Construction Industry's Organization for Working Environment Safety and Health. A cohort was created with information on tobacco use and other risk factors, collected through questionnaires.
In total, 118,395 nonsmoking men without a history of myocardial infarction were followed through 2004. Information on myocardial infarction morbidity and mortality was obtained from national registers. Relative risk estimates were derived from Cox proportional hazards regression model, with adjustment for age, body mass index and region of residence.
Almost 30% of the men had used snuff. In total, 118 395 nonsmoking men without a history of myocardial infarction were followed through 2004. The multivariable-adjusted relative risks for ever snuff users were 0.91 (95% confidence interval, 0.81-1.02) for nonfatal cases and 1.28 (95% confidence interval, 1.06-1.55) for fatal cases. Heavy users (>or=50 g day(-1)) had a relative risk of fatal myocardial infarction of 1.96 (95% confidence interval, 1.08-3.58). Snuff use increased the probability of mortality from cardiovascular disease amongst nonfatal myocardial infarction patients.
Our results indicate that snuff use is associated with an increased risk of fatal myocardial infarction.

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Available from: Maria-Pia Hergens, Sep 16, 2014
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    • "snus use data was excluded from most of the studies (e.g., [10] [11] [12] [13]). In these studies of snus use, exclusion of participants for whom snus use data was not collected after 1977 resulted in elimination of more than 30,000 male participants from the analysis (this is a rough estimate as this aspect of the methodology is very unclear). "
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    ABSTRACT: The accuracy and appropriateness of an analysis often cannot be verified by the contemporary peer review process. Peer review is also unlikely to identify possible publication bias in situ (PBIS) (running many different statistical models but only reporting the results of one, often an outlier result). A review of articles reporting analyses of a cohort of Swedish construction workers revealed unacknowledged and unexplained variations in methodology, including the use of different variables measuring tobacco use, age and body mass index and a failure to adequately and accurately reference previous related articles about the cohort. Seemingly minor changes in methodology, such as the cutoffs used to convert continuous variables to categorical variables may result in significant changes to the results. These inconsistencies were likely not discovered during the peer review process as it would have required that reviewers conduct a systematic review of previous analyses of the dataset. Practical solutions to this dilemma include enhanced post publication review and ensuring that data are available for secondary analysis.
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    • "Through the personal identity number [30] we linked data on smoking and moist snuff use obtained from some Swedish construction workers [31,32], with data on CD from Sweden’s 28 pathology departments [33]. "
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    ABSTRACT: Background Smoking status has been linked to several chronic inflammatory conditions but earlier research on smoking and celiac disease (CD) is contradictive. There are little data on moist snuff use and CD. The purpose of this study was to investigate the association between smoking, moist snuff use and later CD. Methods We identified individuals with biopsy-verified CD (villous atrophy, histopathology stage Marsh III) through biopsy-reports from Sweden’s 28 pathology departments. Data on smoking and moist snuff were collected from the Swedish construction worker database “Bygghälsan” that includes preventive health care check-up data. Through poisson regression we calculated relative risks (RRs) for later CD according to smoking status (n = 305,722), and moist snuff status (n = 199,200) adjusting for age, sex and decade. Results During follow-up 488 individuals with smoking data, and 310 with moist snuff data had a diagnosis of CD. The risk of CD was independent of smoking status with all RRs being statistically insignificant and ranging between 0.9 and 1.0. Compared to non-smokers, neither current smokers (RR = 0.93; 95% CI = 0.76-1.14) nor ex-smokers (RR = 0.98; 95% CI = 0.75-1.28) were at increased or decreased risk of CD. Risk estimates were similar in moderate smokers (RR = 0.92; 0.72-1.16) and heavy smokers (RR = 0.95; 0.74-1.24), and did not change when we examined the risk more than ten years after health examination (RR-moderate: 0.90; and RR-heavy: 0.95; both p > 0.05). Moist snuff use was not associated with later CD (RR = 1.00; 0.78-1.28), or with CD after more than ten years of follow-up (RR = 1.05; 0.80-1.38). Conclusions We found no association between smoking, moist snuff use and future CD.
    BMC Gastroenterology 07/2014; 14(1):120. DOI:10.1186/1471-230X-14-120 · 2.37 Impact Factor
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    • "Although it was suggested that snus use might slightly increase the risk for a more severe outcome in patients with stroke and a nonfatal myocardial infarction. (Hergens et al., 2007). "
    The Journal of Smoking Cessation 01/2014; 9(2):53-59. DOI:10.1017/jsc.2014.27
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