Discontinuation of Smokeless Tobacco and Mortality Risk After Myocardial Infarction

Jul 03, 2014
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Authors:
Arefalk G, Hambraeus K, Lind L, Michaëlsson K, Lindahl B, Sundström J.
Citation:
Circulation 2014;Jun 23:[Epub ahead of print].
Summary By:
Melvyn Rubenfire, MD, FACC

Study Questions:

Does discontinuation of snus (oral moist snuff wrapped in a tiny tea bag) use after a myocardial infarction (MI) reduce mortality risk?

Methods:

All patients who were admitted to coronary care units for an MI in Sweden between 2005 and 2009 and were under the age of 75 underwent a structured examination 2 months post-discharge (the baseline of the present study). The risk of mortality in post-MI snus quitters (n = 675) relative to post-MI continuous snus users (n = 1,799) was compared using Cox proportional hazards analyses.

Results:

During follow-up (mean 2.1 years), 83 participants died. The mortality rate in post-MI snus quitters was 9.7 (95% confidence interval [CI], 5.7-16.3)/1,000 person-years-at-risk and in post-MI continuous snus users 18.7 (95% CI, 14.8-23.6)/1,000 person-years-at-risk. Adjusting for age and gender, post-MI snus quitters had half the mortality risk of post-MI continuous snus users (hazard ratio, 0.51; 95% CI, 0.29-0.91). In a multivariable-adjusted model, the hazard ratio was 0.57 (95% CI, 0.32-1.02). The corresponding estimate for post-MI smoke quitters versus post-MI continuous smokers was 0.54 (95% CI, 0.42-0.69).

Conclusions:

Discontinuation of snus use post-MI was associated with a nearly halved mortality risk, similar to the benefit associated with smoking cessation. These observations suggest that the use of snus post-MI should be discouraged.

Perspective:

Snus (pronounced snoose and produced in Sweden and banned in most of Europe) is gaining popularity in the United States as a smokeless tobacco. It is high in nicotine, but is said to be lower in carcinogens. This very important study demonstrates the hazard of nicotine post-MI that is independent of the inhaled micro particles, and should be a warning to snuff users. The findings are in conflict with previous studies that concluded snus is the least harmful of the smokeless tobacco products and that there is a 95-99% reduction in health risk compared to cigarettes.


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