June 23rd, 2014
If You Snus, You Lose: Study Shows Benefits of Quitting Smokeless Tobacco
The adverse effects of smoking are well known and documented. The effect of smokeless tobacco is less clear. Now a study from Sweden, published in Circulation, offers evidence that quitting smokeless tobacco after MI is about as beneficial as quitting smoking. The results do not support the common view that smokeless tobacco is a safe alternative to smoking.
In their main analysis, the investigators analyzed the risk for death in Swedish MI patients, 675 of whom had quit using snus (the Swedish form of oral snuff) after MI and 1799 of whom continued to use snus. After 2.1 years of follow-up, the mortality rate was reduced in half among those who quit relative to those who continued using snus, from 18.7 to 9.7 per 1000 person-years. After adjustment for other risk factors, the hazard ratio for quitters was 0.57, similar to the 0.54 HR seen in a separate analysis among those who quit smoking after MI compared with those who continued to smoke.
“We didn’t expect to see such a strong association among those people who stopped using (smokeless tobacco),” said lead author Gabriel Arefalk, in an AHA press release. “After a heart attack, no doubt smoking cessation reduces the risk of death approximately one third and is really a cornerstone of cardiac rehabilitation worldwide. For smokeless tobacco, we did not know.”