Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 Aug 18:339:b3060.
doi: 10.1136/bmj.b3060.

Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis

Paolo Boffetta  1 , Kurt Straif
Affiliations
Review

Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis

Paolo Boffetta et al. BMJ. .

Abstract

Objective: To assess whether people who use smokeless tobacco products are at increased risk of myocardial infarction and stroke.

Design: Meta-analysis of observational studies from Sweden and the United States.

Data sources: Electronic databases and reference lists.

Data extraction: Quantitative estimates of the association between use of smokeless tobacco products and risk of myocardial infarction and stroke among never smokers.

Review methods: Both authors independently abstracted risk estimates and study characteristics. Summary relative risks were estimated on the basis of random effects models.

Results: 11 studies, mainly in men, were included. Eight risk estimates were available for fatal myocardial infarction: the relative risk for ever use of smokeless tobacco products was 1.13 (95% confidence 1.06 to 1.21) and the excess risk was restricted to current users. The relative risk of fatal stroke, on the basis of five risk estimates, was 1.40 (1.28 to 1.54). The studies from both the United States and Sweden showed an increased risk of death from myocardial infarction and stroke. The inclusion of non-fatal myocardial infarction and non-fatal stroke lowered the summary risk estimates. Data on dose-response were limited but did not suggest a strong relation between risk of dying from either disease and frequency or duration of use of smokeless tobacco products.

Conclusion: An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Strategy for selection of studies in meta-analysis
None
Fig 2 Forest plot of risk estimates for fatal myocardial infarction among users of smokeless tobacco products
None
Fig 3 Forest plot of risk estimates for fatal stroke among users of smokeless tobacco products
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Vol 89. Smokeless tobacco products. Lyon: IARC, 2008. - PMC - PubMed
    1. Rodu B, Godshall WT. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Harm Reduct J 2006;3:37. - PMC - PubMed
    1. Broadstock M. Systematic review of the health effects of modified smokeless tobacco products. NZHTA Report 2007;10:1-129.
    1. SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks). Scientific opinion on the health effects of smokeless tobacco products. Brussels: European Commission, 2008. http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_....
    1. Lee PN. Circulatory disease and smokeless tobacco in Western populations: a review of the evidence. Int J Epidemiol 2007,36:789-804. - PubMed