Published online before print May 29, 2003, doi: 10.1161/01.STR.0000076011.02935.A1
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2003;34:1754.)
© 2003 American Heart Association, Inc.
Original Contributions |
Smokeless Tobacco as a Possible Risk Factor for Stroke in Men
A Nested Case-Control Study
From Medicine and Epidemiology, Department of Public Health and Clinical Medicine, University Hospital, Umeå, Sweden.
Correspondence to Professor Kjell Asplund, Department of Medicine, University Hospital, S-901 85 Umeå, Sweden. E-mail Kjell.Asplund{at}medicin.umu.se
Background and Purpose— Snuff and other forms of smokeless tobacco are widely used in some populations. Whereas the detrimental cardiovascular effects of smoking are well documented, possible health hazards associated with the use of smokeless tobacco remain controversial. The purpose of this study was to explore whether the use of snuff, a smokeless tobacco product, increases the risk of stroke in men.
Methods— In a nested case-control study (1 case and 2 matched controls without cardiovascular disease), information on tobacco habits was collected through population risk factor surveys. During follow-up, first-ever fatal and nonfatal strokes occurring among 25- to 74-year-old participants were identified in a population-based stroke register. The study was restricted to men (276 cases, 551 controls).
Results— The unadjusted odds ratio for stroke in regular cigarette smokers compared with men who never used tobacco was 2.21 (95% CI, 1.29 to 3.79). When never-smoking regular snuff dippers (excluding ex-smokers) were compared with men who never used tobacco, the unadjusted odds ratio was 1.05 (95% CI, 0.37 to 2.94). The odds ratio for never-snuffing smokers versus never-smoking snuff users was 2.90 (95% CI, 0.92 to 9.1). After adjustment for multiple cardiovascular risk factors, the odds ratio for having a stroke was 1.74 (95% CI, 0.85 to 3.54) in regular smokers and 0.87 (95% CI, 0.41 to 1.83) in regular snuff users.
Conclusions— Whereas regular smoking doubles the risk of stroke in men, snuff use is not associated with any apparent excess risk. Chemical moieties produced by burning tobacco are probably the most important contributors to smokers’ excess risk of atherothrombotic disease, including stroke.
Key Words: case-control studies • cigarette smoking • stroke • tobacco, smokeless
This article has been cited by other articles:
 |
|
 |
|
  W. G. Mayhan, D. M. Arrick, G. M. Sharpe, and H. Sun Nitric oxide synthase-dependent responses of the basilar artery during acute infusion of nicotine Nicotine Tob Res, March 1, 2009; 11(3): 270 - 277. [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]
|
|
|
|
 |
|
 D. M. Arrick and W. G. Mayhan Acute infusion of nicotine impairs nNOS-dependent reactivity of cerebral arterioles via an increase in oxidative stress J Appl Physiol, December 1, 2007; 103(6): 2062 - 2067. [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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
Q. Fang, H. Sun, D. M. Arrick, and W. G. Mayhan Inhibition of NADPH oxidase improves impaired reactivity of pial arterioles during chronic exposure to nicotine J Appl Physiol, February 1, 2006; 100(2): 631 - 636. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
C Bates, K Fagerstrom, M J Jarvis, M Kunze, A McNeill, and L Ramstrom European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health Tob. Control, December 1, 2003; 12(4): 360 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S L Tomar, G N Connolly, J Wilkenfeld, and J E Henningfield Declining smoking in Sweden: is Swedish Match getting the credit for Swedish tobacco control's efforts? Tob. Control, December 1, 2003; 12(4): 368 - 371. [Full Text] [PDF]
|
|
|
|
|
|
Bibliography Scand J Public Health, November 1, 2003; 31(61_suppl): 85 - 91. [PDF]
|
|