SMOKELESS TOBACCO (SNUS) AND RISK OF HEART FAILURE IN TWO SWEDISH COHORTS: PP.1.06

Objective: Oral moist snuff (snus) is discussed as a safer alternative to smoking, and its use is increasing. Based on its documented effect on blood pressure, we hypothesized that snus use increases the risk of heart failure. Design and Method: We investigated associations of snus use with risk of a first hospitalization for heart failure in two Swedish cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1,076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers. Results: In ULSAM, 95 men were hospitalized for heart failure, during a median follow-up of 8.9 years. In a Cox proportional hazards model adjusted for established risk factors including past and present smoking exposure, snus use was associated with a higher risk of heart failure (hazard ratio 2.08; 95% confidence interval [CI] 1.03–4.22) relative to non-use. This excess risk was similar to that linked to smoking. Snus use was particularly associated with risk of non-ischemic heart failure (hazard ratio 2.55; 95% CI 1.12–5.82). In CWC, 545 men were hospitalized for heart failure, during a median follow-up of 18 years. In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (hazard ratio 1.28; 95% CI 1.00–1.64) and non-ischemic heart failure (hazard ratio 1.28; 95% CI 0.97–1.68) relative to never-use of any tobacco. Conclusions: Data from two independent cohorts indicate that use of snus is associated with a higher risk of heart failure. This may have public health implications.