Maria-Pia Hergens1, Rosaria Galanti, Jenny Hansson, Peeter Fredlund, Anders Ahlbom, Lars Alfredsson, Rino Bellocco, Marie Eriksson, Eleonor I Fransson, Johan Hallqvist, Jan-Håkan Jansson, Anders Knutsson, Nancy Pedersen, Ylva Trolle Lagerros, Per-Olof Ostergren, Cecilia Magnusson. 1. From the aDepartment of Communicable Disease Control, Stockholm County Council, Stockholm, Sweden; bDepartment of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; cCentre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden; dInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; eDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; fDepartment of Statistics, University of Milano-Bicocca, Milano, Italy; gDepartment of Statistics, Umeå University, Umeå, Sweden; hSchool of Health Science, Jönköping University, Jönköping, Sweden; iDepartment of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; jDepartment of Medicine, Umeå University, Umeå, Sweden; kDepartment of Health Sciences, Mid Sweden University, Sundsvall, Sweden; lUnit of Clinical Epidemiology, Dept of Medicine, Karolinska Institutet, Stockholm, Sweden; and mSocial Medicine and Global Health, Department of Clinical Sciences In Malmö, Lund University, Lund, Sweden.
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.
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.
Authors: Bulent Gorenek; Antonio Pelliccia; Emelia J Benjamin; Giuseppe Boriani; Harry J Crijns; Richard I Fogel; Isabelle C Van Gelder; Martin Halle; Gulmira Kudaiberdieva; Deirdre A Lane; Torben Bjerregaard Larsen; Gregory Y H Lip; Maja-Lisa Løchen; Francisco Marin; Josef Niebauer; Prashanthan Sanders; Lale Tokgozoglu; Marc A Vos; David R Van Wagoner; Laurent Fauchier; Irina Savelieva; Andreas Goette; Stefan Agewall; Chern-En Chiang; Márcio Figueiredo; Martin Stiles; Timm Dickfeld; Kristen Patton; Massimo Piepoli; Ugo Corra; Pedro Manuel Marques-Vidal; Pompilio Faggiano; Jean-Paul Schmid; Ana Abreu Journal: Eur J Prev Cardiol Date: 2016-11-04 Impact factor: 7.804
Authors: Bulent Gorenek; Antonio Pelliccia; Emelia J Benjamin; Giuseppe Boriani; Harry J Crijns; Richard I Fogel; Isabelle C Van Gelder; Martin Halle; Gulmira Kudaiberdieva; Deirdre A Lane; Torben Bjerregaard Larsen; Gregory Y H Lip; Maja-Lisa Løchen; Francisco Marín; Josef Niebauer; Prashanthan Sanders; Lale Tokgozoglu; Marc A Vos; David R Van Wagoner; Laurent Fauchier; Irina Savelieva; Andreas Goette; Stefan Agewall; Chern-En Chiang; Márcio Figueiredo; Martin Stiles; Timm Dickfeld; Kristen Patton; Massimo Piepoli; Ugo Corra; Pedro Manuel Marques-Vidal; Pompilio Faggiano; Jean-Paul Schmid; Ana Abreu Journal: Europace Date: 2017-02-01 Impact factor: 5.214