Table 1

Cohort studies and pooled analyses of smokeless tobacco use and circulatory risks

StudyCountryStudy populationStudy periodSexAge at baselineStudy sizeSmokeless tobacco typeOutcomesICD codesNewcastle-Ottawa score
Bolinder et al 22
1994
SwedenConstruction workers receiving medical check-ups from the Organisation for Working Environment Safety and HealthBaseline visit in 1971–1974 with mortality follow-up from 1974 to 1985M≤65 years84 781
6927 smokeless users
SnusMortality from IHD, stroke and CIDIHD (ICD-8 410–414); stroke (ICD-8 430–438); all CID (ICD-8 390–458)6
Accortt et al 33
2002
USANHANES I Epidemiologic Follow-up Survey (NHEFS) participantsNHANES I was conducted from 1971 to 1975 and NHEFS follow-up occurred in 1982–1984, 1986, 1987 and 1992M, F45–75 years12 172
505 exclusive smokeless tobacco users
Smokeless tobaccoMortality from IHD, stroke and all CIDIHD (ICD-9 codes 410–414); stroke (ICD-9 codes 430–438); all CID (ICD-9 codes 390–459)9
Henley et al 34
2005
USAParticipants in American Cancer Society's Cancer Prevention Study (CPS) IBaseline survey in 1959 with mortality follow-up through 1972M≥30 years77 407
7745 current smokeless tobacco users
Smokeless tobacco, snuff, chewing tobaccoMortality from coronary heart disease, stroke, other CID and all CIDCoronary heart disease (ICD-7 420); stroke (330-334); other CID (ICD-7 335–398, 400–419, 421–468); all CID (ICD-7 330–468)8
Henley et al 34
2005
USAParticipants in CPS IIBaseline survey in 1982 with mortality follow-up through 2000M≥30 years114 809
2488 current smokeless tobacco users
Smokeless tobacco, snuff, chewing tobaccoMortality from coronary heart disease, stroke, other CID and all CIDCoronary heart disease (ICD-9 410–414); stroke (ICD-9 430–438); other CID (ICD-9 390–405, 415–429, 450–459); all CID (ICD-9 390–459)8
Johansson et al 23
2005
SwedenParticipants in the Swedish Annual Level-of-Living Survey (SALLS)Baseline survey in 1988–1989 with follow-up through 2000M30–74 years3120
107 never smoking daily smokeless tobacco users
SnusIncidence and mortality from coronary heart diseaseCoronary heart disease (ICD-9 410–414 and ICD-10 I20–I25)8
Haglund et al 24
2007
SwedenParticipants in the Swedish Survey of Living Conditions (ULF)Baseline survey in 1988–1989 with follow-up through 2003M16–74 years5002
885 smokeless tobacco users
SnusIncidence and mortality from IHD and strokeIHD (ICD-9 410–414 and ICD-10 I20–I25); stroke (ICD-9 430–438 and ICD-10 I60–I69)7
Henley et al35
2007
USAFormer smokers participating in CPS IIBaseline survey in 1982 with mortality follow-up through 2002M≥30 years116 395
4443 smokeless tobacco users
Smokeless tobacco, chewing tobacco and snuffMortality from coronary heart disease and strokeCoronary heart disease (ICD-9 410–414) and stroke (ICD-9 430–438)6
Hergens et al 25
2007
SwedenConstruction workers receiving medical check-ups from the Organisation for Working Enviroment Safety and HealthBaseline was first visit after 1978 to 1993 with follow-up through 2004M35–65 years (for analysis)118 395
~32 360 current smokeless tobacco users
SnusIncidence and mortality from acute myocardial infarctionAcute myocardial infarction (ICD-9 410 and ICD-10 I21–I22)7
Hergens et al 26
2008
SwedenConstruction workers receiving medical check-ups from the Organisation for Working Enviroment Safety and HealthBaseline was first visit after 1978 to 1993 with follow-up through 2003M<35–55+ years118 465
27% current smokeless tobacco users
SnusIncidence and mortality from strokeStroke (ICD-7 through ICD-10)7
Hergens et al 32
2008
SwedenConstruction workers receiving medical check-ups from the Organisation for Working Enviroment Safety and HealthBaseline was first visit after 1978 to 1993M<45–65+ years120 930
32 973 current smokeless tobacco users
SnusIncidence of hypertensionHypertension (ICD-7 440–447, ICD-8 400–404, ICD-9 401–405 and ICD-10 I10–I15)6
Roosaar et al 27
2008
SwedenParticipants from two municipalities in Uppsala County, SwedenBaseline interview was in 1973–1974 with follow-up through 2002M≥14 years9976
1548 ever daily smokeless tobacco users
SnusMortality from CIDAll CID (ICD-8 390–458, ICD-9 390–458 and ICD-10 I00–I99)7
Hansson et al 28
2009
SwedenParticipants from the Swedish Twin Registry who took part in the Screening Across the Lifespan Twin Study (SALT)Telephone interview conducted in 1998–2002 with follow-up through 2005M≥40 years16 642
2661 current smokeless tobacco users
SnusIncidence and mortality from acute myocardial infarction, coronary revascularisation and strokeAcute myocardial infarction and coronary revascularisation (ICD-10 I20–I21, I24–I25 excluding I25.2) and stroke (ICD-9 430–431, 433–436; ICD-10 I60–I61, I63–I64, G45)7
Janzon et al 29
2009
SwedenParticipants in the Malmo Cancer and Diet Study (MCDS)Baseline examination from 1991 to 1996 with follow-up through 2004M45–73 years10 473
737 smokeless tobacco users
SnusIncidence of acute myocardial infarction and stroke or mortality from IHDAcute myocardial infarction (ICD-9 410), IHD (ICD-9 410–414) and stroke (ICD-9 430, 431, 434 and 436)8
Yatsuya et al 10
2010
USAParticipants in the Atherosclerosis Risk in Communities studyRecruitment in 1987–1989 with follow-up through 2005M45–64 years14 498
456 current smokeless tobacco users
Smokeless tobaccoIncidence or mortality from coronary heart disease and incidence of strokeNot provided8
Arefalk et al 30
2012
SwedenParticipants in the Uppsala Longitudinal Study of Adult Men (ULSAM); participants in the Construction Worker’s Cohort (CWC)ULSAM—baseline survey in 1970–1973 with follow-up from 1991 to 1995 through 2002; CWC—baseline check-up was from 1978 on with follow-up through 2003MULSAM—50 years; CWC—mean age of 31.5 yearsULSAM—1076
78 smokeless tobacco users;
CWC—118 425
32 281 current smokeless tobacco users
SnusULSAM and CWC—incidence of heart failureCWC—heart failure (ICD-7 434.1, 434.2, 440.99 and 441.99; ICD-8 427.00, 427.10 and 428.99; ICD-9 428; ICD-10 I50, I11.0)6
Arefalk et al 31
2014
SwedenParticipants in SWEDEHEART database registriesSnus users who were admitted to a coronary care unit with myocardial infarction from 2005 to 2009 were identified from patient databasesM and FMean 61.9 years675 snus quitters
1799 snus users after myocardial infarction
SnusIncidence or mortality from repeat myocardial infarction, stroke and heart failureAcute myocardial infarction (ICD-10 I21–I23), stroke (ICD-10 I60–I64) and heart failure (ICD-10 I50)5
Timberlake et al 9
2017
USAParticipants in the National Longitudinal Mortality StudyParticipants completed the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) from 1985 to 2011 with follow-up through 2011MNot stated349 282
4919 current smokeless tobacco users
Smokeless tobacco, snuff and chewing tobaccoMortality from coronary heart disease and strokeCoronary heart disease and stroke as categorised in standardised list of causes of death based on ICD-9 and ICD-107
Pooled analyses
Hansson et al 18
2012
SwedenParticipants from eight cohort studies—CWC, MCDS, MONICA, National March Cohort, SALT, Stockholm Public Health Cohort, Scania Public Health Cohort, and Work, Lipids and Fibrinogen StudyRecruitment ranged from 1978 to 2004Mmean age of recruitment was 35 years130 361
25% current smokeless tobacco users
SnusIncidence and mortality from acute myocardial infarctionAcute myocardial infarction (ICD-7 410.10 and 420.17; ICD-8 410; ICD-9 410; ICD-10 I21)8
Hansson et al 19
2014
SwedenParticipants from eight cohort studies—CWC, MCDS, MONICA, National March Cohort, SALT, Stockholm Public Health Cohort, Scania Public Health Cohort, and Work, Lipids and Fibrinogen StudyRecruitment ranged from 1978 to 2004MMean age of recruitment was 35 years130 485
32 542 current smokeless tobacco users
SnusIncidence and mortality from strokeStroke (ICD-9 430–431, 434 and 436; ICD-10 I60–I61, I63 and I64; and corresponding codes for ICD-7 and ICD-8)8
  • CID, circulatory disease;IHD, ischaemic heart disease; MONICA, Multinational Monitoring of Trends and Determinants in Cardiovascular Health; NHANES, National Health and Nutrition Examination Survey.