European Journal of Epidemiology

, Volume 27, Issue 10, pp 771–779 | Cite as

Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies

  • Jenny HanssonEmail author
  • Maria Rosaria Galanti
  • Maria-Pia Hergens
  • Peeter Fredlund
  • Anders Ahlbom
  • Lars Alfredsson
  • Rino Bellocco
  • Marie Eriksson
  • Johan Hallqvist
  • Bo Hedblad
  • Jan-Håkan Jansson
  • Peter Nilsson
  • Nancy Pedersen
  • Ylva Trolle Lagerros
  • Per-Olof Östergren
  • Cecilia Magnusson


The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke “potential reduction exposure product”. Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.


Acute myocardial infarction Smokeless tobacco Snus The Swedish collaboration on health effects of snus use 



Acute myocardial infarction


Body mass index


Confidence intervals


Hazard ratio


International Classification of Diseases


Ischemic heart disease


Odds ratio



We thank Kontie Moussa, Eleonor Fransson, Annika Gustavsson and Tomas Andersson for their contributions to this paper. This study was funded by grants from the Stockholm County Council, the Swedish Research Council (grant n o. 2007-3185), National Institute of Public Health (grant no. 2008/188), and the Swedish Council for Working Life and Social Research (grant no. 2010-0546). The Northern Sweden MONICA study was supported by grants from Norrbotten and Västerbotten County Councils, the Swedish Research Council, the Joint Committee of Northern Sweden Health Care Region (Visare Norr), the Heart and Chest Foundation, the Stroke fund, King Gustaf V’s and Queen Victoria’s Foundation, the Vårdal Foundation and the Social Sciences Research Council. The Wolf study was supported by the Swedish Council for Working Life and Social Research.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Jenny Hansson
    • 1
    Email author
  • Maria Rosaria Galanti
    • 1
  • Maria-Pia Hergens
    • 2
  • Peeter Fredlund
    • 1
  • Anders Ahlbom
    • 3
  • Lars Alfredsson
    • 3
  • Rino Bellocco
    • 2
    • 4
  • Marie Eriksson
    • 5
  • Johan Hallqvist
    • 6
  • Bo Hedblad
    • 7
  • Jan-Håkan Jansson
    • 8
  • Peter Nilsson
    • 7
  • Nancy Pedersen
    • 2
  • Ylva Trolle Lagerros
    • 9
  • Per-Olof Östergren
    • 10
  • Cecilia Magnusson
    • 1
  1. 1.Division of Public Health Epidemiology, Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  3. 3.Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
  4. 4.Department of StatisticsUniversity of Milano-BicoccaMilanItaly
  5. 5.Department of StatisticsUmeå University UmeåSweden
  6. 6.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  7. 7.Department of Clinical Sciences, Skåne University HospitalLund UniversityMalmöSweden
  8. 8.Department of Public Health and Clinical MedicineUmeå University UmeåSweden
  9. 9.Department of Medicine, Unit of Clinical EpidemiologyKarolinska InstitutetStockholmSweden
  10. 10.Social Medicine and Global Health, Department of Clinical SciencesLund UniversityLundSweden

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