Discontinuation of Smokeless Tobacco Post-Myocardial Infarction Linked to Better Survival Chances

In this prospective cohort study, presented today at the ESC Congress 2011, discontinuation of smokeless tobacco after a myocardial infarction (MI) is associated with a lower risk of subsequent mortality. Investigators found that post MI snus quitters had a 44 % lower risk of total mortality.The association seems to be independent of smoking habits, but partly explained by concomitant changes in other lifestyle variables. Smokeless tobacco in the form of Swedish snus (oral moist snuff) has been advocated as a safer alternative to smoking. Snus takes the form of a finely ground and moistened tobacco, a bolus of which is placed under the upper lip for around an hour, with daily exposure times estimated to be around 10 to 12 hours. Different formulations exist from loose tobacco to sachets. In Sweden, 20% of adult males and 4% of adult females are estimated to be daily users. The sale of snus is illegal in the rest of the European Union, but widespread and increasing in the United States. "While cigarettes are indeed associated with more negative health effects, smokeless tobacco can't be regarded as harmless," said Gabriel Arefalk from Uppsala University (Uppsala, Sweden), the first author of the study. "In Sweden every time we discharge an MI patient who's a snus user, we're faced with the clinically important question of whether they should discontinue use." Of concern, he added, has been a meta-analysis suggesting that use of smokeless tobacco results in an increased risk for fatal MIs, indicating that snus use may predispose people to arrhythmic or other serious complications of MIs.