Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation

Epidemiology. 2014 Nov;25(6):872-6. doi: 10.1097/EDE.0000000000000169.

Abstract

Background: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.

Methods: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.

Results: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.

Conclusion: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atrial Fibrillation / chemically induced*
  • Atrial Fibrillation / epidemiology
  • Humans
  • Male
  • Prevalence
  • Prospective Studies
  • Registries
  • Risk
  • Risk Factors
  • Sweden / epidemiology
  • Tobacco, Smokeless / toxicity*