Research just published on bmj.com reports that people who use smokeless tobacco products like snus (a moist powder tobacco product) have a slightly higher risk of having a fatal heart attack or stroke.

Over the last couple of decades, there has been an increase in the number of people in Europe and North America using smokeless tobacco. Most new users are aged under 40. According to the study, since these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is expected to increase.

Dr Paolo Boffetta at International Agency for Research on Cancer in France led the research team. They examined the results of 11 studies carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke.

In order to reduce partiality, variations in study plan and features were considered.

Results indicated there was a small increased risk of death from a heart attack or stroke among users of smokeless tobacco products compared with non-users. Smokeless tobacco was responsible for 0.5 percent of all heart attacks in the United States and 5.6 percent in Sweden. The products were also the cause of 1.7 percent of stroke deaths in the United States and 5.4 percent in Sweden.

In closing, the authors say that the degree of the excess risk was small, particularly for fatal myocardial infarction. However, the reliability of the results among studies and their strength with respect to study design and quality added to their credibility.

If the connection is accurate, the authors consider that its public health and clinical implications might be important and they recommend further research in this area.

"Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis"
Paolo Boffetta, epidemiologist Kurt Straif, epidemiologist
BMJ 2009; 339:b3060
bmj.com

Written by Stephanie Brunner (B.A.)