Snus use and cardiovascular risk factors in the general population: the HUNT3 study

Addiction. 2013 Nov;108(11):2019-28. doi: 10.1111/add.12313. Epub 2013 Aug 28.


Background and aims: Snus, a form of smokeless tobacco, is increasingly popular in its traditional Nordic markets, and was recently launched commercially in the United States. We examined the cross-sectional associations between snus use and cardiovascular risk factors, and compared them with the corresponding associations of smoking.

Design: Cross-sectional study.

Setting: The HUNT3 general population survey, Nord-Trøndelag, Norway (2006-08).

Participants: A general population sample of n = 25 163.

Measurements: Measured triglyceride,- glucose- and high-density lipoprotein (HDL)-cholesterol levels, blood pressure and waist circumference, registry information on gender, age and education level, self-reported snus use, smoking, physical exercise and alcohol use.

Findings: In age- and gender-adjusted linear regression analyses, extensive snus use was associated with larger waist circumference (b = 1.65, 95% CI = 0.86, 2.43) and higher systolic blood pressure (b = 2.58, 95% CI = 1.48, 3.68), but with higher rather than lower levels of HDL-cholesterol (b = 1.66, 95% CI = 0.79, 2.53). These three differences remained significant after additional adjustment for smoking, education level, physical exercise and alcohol use. Smokers had higher triglyceride and lower HDL-cholesterol than snus users, but lower systolic blood pressure.

Conclusions: After adjusting statistically for major confounding variables, Norwegians who use snus extensively have a mixed profile in terms of cardiovascular risk: slightly higher waist circumference and systolic blood pressure but also higher high-density lipoprotein-cholesterol.

Keywords: Cardiovascular risk; smokeless tobacco; smoking; snus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Alcohol Drinking / epidemiology*
  • Blood Pressure / physiology*
  • Cholesterol / blood*
  • Cross-Sectional Studies
  • Educational Status
  • Exercise
  • Female
  • Humans
  • Male
  • Middle Aged
  • Norway / epidemiology
  • Risk Factors
  • Sex Factors
  • Smoking / epidemiology*
  • Tobacco, Smokeless*
  • Waist Circumference*
  • Young Adult


  • Cholesterol