Chronic snus use in healthy males alters endothelial function and increases arterial stiffness

PLoS One. 2022 Jun 3;17(6):e0268746. doi: 10.1371/journal.pone.0268746. eCollection 2022.


Background: Snus usage is commonly touted as a safer alternative to cigarette smoking. However, recent studies have demonstrated possible adverse cardiovascular effects in chronic snus users. The present study evaluates the effects of chronic snus use on vascular function by assessing central arterial stiffness and endothelial vasodilatory function in healthy chronic snus users as compared to matched non-users.

Methods and results: Fifty healthy males (24 snus users, 26 age-matched controls) with a mean age of 44 years were included in the study. Arterial stiffness was assessed employing both pulse wave velocity and pulse wave analysis. Endothelial vasodilatory function was measured by venous occlusion plethysmography, utilizing intra-arterial administration of acetylcholine, glyceryl trinitrate and bradykinin to further gauge endothelium-dependent and -independent vasodilatory function. Arterial stiffness was significantly higher in chronic snus users as compared to controls: pulse wave velocity [m/s]: 6.6±0.8 vs 7.1±0.9 resp. (p = 0.026), augmentation index corrected for heart rate [%]: 0.1±13.2 vs 7.3±7.8 resp. (p = 0.023). Endothelial independent vasodilation, i.e. the reaction to glyceryl trinitrate, was significantly lower in snus users as measured by venous occlusion plethysmography.

Conclusions: The results of this study show an increased arterial stiffness and an underlying endothelial dysfunction in daily snus users as compared to matched non-tobacco controls. These findings indicate that long-term use of snus may alter the function of the endothelium and therefore reinforces the assertion that chronic snus use is correlated to an increased risk of development of cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Endothelium
  • Endothelium, Vascular
  • Humans
  • Male
  • Nitroglycerin / pharmacology
  • Pulse Wave Analysis / methods
  • Tobacco, Smokeless*
  • Vascular Stiffness* / physiology


  • Nitroglycerin

Grants and funding

This work was supported by the Swedish Society of Medicine, the Swedish Heart-lung foundation, the Swedish Heart and Lung Association, the Tornspiran Foundation, Magnus Bergvall foundation and Västerbotten County Council. Dr. Magnus Lundbäck is supported by a clinical post-doctoral support from Karolinska Institutet and Stockholm County Council.