Swedish snus use in non-smoking middle-aged men and risk of cardiovascular disease: a population-based cohort study with 27-year follow-up

Aims: The potential health hazards associated with snus use are less studied compared with the health risks related to smoking. However, during the past decade there is growing evidence on increased risk for mortality, cardiovascular disease (CVD) and cancer following snus use. The aim of the present study was to examine the possible association between snus use at the age of 40 and 50 years, and the development of coronary heart disease (CHD), stroke, hypertension, or heart failure later in life in men with no history of smoking. Methods: Data from a population-based cohort with data from health examinations at 40 or 50 years of age, performed between 1990 and 1999 was used to identify non-smoking men that used snus or not. Crude and adjusted associations of snus use and first diagnosis of CHD, stroke, hypertension or heart failure and all-cause mortality were analysed for the age groups separately, using Cox proportional hazards regression models. Results: A total of 4222 non-smoking men were included, of which 458 (10.8%) used snus. The adjusted hazard ratios for a first diagnosis of hypertension were 1.64 (95% confidence interval (CI) 1.36–1.98), and 1.75 (95% CI 1.17–2.62) for heart failure, for 50-year-old, snus using men. Conclusions: Snus use among non-smoking 50-year-old men was associated with an increased risk for hypertension and heart failure later in life, after adjustment for known risk factors for CVD. However, the associations were insignificant for CHD, stroke and all-cause mortality.