• Gabriel Arefalk, Maria-Pia Hergens, Erik Ingelsson, Johan Arnlöv, Karl Michaëlsson, Lars Lind, Weimin Ye, Olof Nyrén, Mats Lambe, and Johan Sundström.
• Department of Medical Sciences, Uppsala University, Uppsala, Sweden. gabriel.arefalk@medsci.uu.se
• Eur J Prev Cardiol. 2012 Oct 1; 19 (5): 1120-7.

BackgroundOral 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 use of snus increases the risk of heart failure.DesignTwo independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers.MethodsCox proportional hazards models were used to investigate possible associations of snus use with risk of a first hospitalization for heart failure.ResultsIn ULSAM, 95 men were hospitalized for heart failure, during a median follow up of 8.9 years. In a model adjusted for established risk factors including past and present smoking exposure, current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.22] relative to non-use. Snus use was particularly associated with risk of non-ischaemic heart failure (HR 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 (HR 1.28, 95% CI 1.00-1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97-1.68) relative to never tobacco use.ConclusionData from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.

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