28 Jul Quitting Snuff/Chew/Dip After Heart Attack May Half Risk of Dying
MedicalResearch.com: Interview with:
Gabriel Arefalk
Department of Medical Sciences
Uppsala University Hospital
Uppsala, Sweden
Medical Research: What are the main findings of the study?
Answer: In this prospective cohort study, we investigated mortality risk in 2474 smokeless tobacco users who had been hospitalized for a myocardial infarction between the years of 2005-2009 in Sweden. We used a nationwide quality register and database called SWEDEHEART and found that those who stopped using snus (the Swedish type of snuff) after their MI had half the risk of dying during follow up relative to those who continued to use snus. This association, which was of the same magnitude as for smoking cessation, seemed to be independent of age, gender and smoking habits, as well as of many other relevant covariates.
Medical Research: Were any of the findings unexpected?
Answer: The new and most surprising finding of this study was that snus users who have a myocardial infarction might benefit equally from discontinuation as smokers.
Another important finding is that only about 30 % of the snus users and 60 % of the smokers actually quit after their myocardial infarction. It is evident that there is a great need for improvement in offering post-MI patients a safe and effective way to achieve tobacco abstinence.
Medical Research: What should clinicians and patients take away from your report?
Answer: One should always be careful about claiming causality when it comes to observational studies. Although there is a need for confirmatory studies, this is the only evidence available so far, and I think post-MI patients should be informed and advised according to the results. Hence, if you have established coronary heart disease, my recommendation would be to give up tobacco in all forms.
Medical Research: What recommendations do you have for future research as a result of this study?
Answer: Ideally, the effects of quitting snus after a myocardial infarction should be studied in a randomized clinical trial. Unfortunately, such a study is not likely to happen, an ethical review board would probably not give approval. We will continue to investigate health effects related to the use of smokeless tobacco.
Citation:
Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction
Last Updated on July 28, 2014 by Marie Benz MD FAAD