• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1994 March; 84(3): 399–404.
PMCID: PMC1614817

Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers.


OBJECTIVES. Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nicotine levels similar to those caused by cigarette smoking. METHODS. Male Swedish construction industry employees (n = 135,036) who attended a health examination were followed by studying cause-specific mortality during a 12-year period. The study population comprised 6297 smokeless tobacco users, 14,983 smokers of fewer than 15 cigarettes per day, 13,518 smokers of 15 or more cigarettes per day, 17,437 ex-smokers, 50,255 "other" tobacco users, and 32,546 nonusers. RESULTS. The age-adjusted relative risk of dying from cardiovascular disease was 1.4 for smokeless tobacco users and 1.9 for smokers of 15 or more cigarettes per day, compared with nonusers. Among men aged 35 through 54 years at the start of follow-up, the relative risk was 2.1 for smokeless tobacco users and 3.2 for smokers. When data were adjusted for body mass index, blood pressure, and history of heart symptoms, the results were essentially unchanged. Cancer mortality was not raised in smokeless tobacco users. CONCLUSIONS. Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Although the risk is lower for smokeless tobacco users than for smokers, the excess risk gives cause for preventive actions.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wilhelmsen L, Svärdsudd K, Korsan-Bengtsen K, Larsson B, Welin L, Tibblin G. Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med. 1984 Aug 23;311(8):501–505. [PubMed]
  • Pittilo RM, Clarke JM, Harris D, Mackie IJ, Rowles PM, Machin SJ, Woolf N. Cigarette smoking and platelet adhesion. Br J Haematol. 1984 Dec;58(4):627–632. [PubMed]
  • Lassila R, Seyberth HW, Haapanen A, Schweer H, Koskenvuo M, Laustiola KE. Vasoactive and atherogenic effects of cigarette smoking: a study of monozygotic twins discordant for smoking. BMJ. 1988 Oct 15;297(6654):955–957. [PMC free article] [PubMed]
  • Pittilo RM. Cigarette smoking and endothelial injury: a review. Adv Exp Med Biol. 1990;273:61–78. [PubMed]
  • Ahmed SS, Moschos CB, Lyons MM, Oldewurtel HA, Coumbis RJ, Regan TJ. Cardiovascular effects of long-term cigarette smoking and nicotine administration. Am J Cardiol. 1976 Jan;37(1):33–40. [PubMed]
  • Gritz ER, Baer-Weiss V, Benowitz NL, Van Vunakis H, Jarvik ME. Plasma nicotine and cotinine concentrations in habitual smokeless tobacco users. Clin Pharmacol Ther. 1981 Aug;30(2):201–209. [PubMed]
  • Benowitz NL, Porchet H, Sheiner L, Jacob P., 3rd Nicotine absorption and cardiovascular effects with smokeless tobacco use: comparison with cigarettes and nicotine gum. Clin Pharmacol Ther. 1988 Jul;44(1):23–28. [PubMed]
  • Bolinder GM, Ahlborg BO, Lindell JH. Use of smokeless tobacco: blood pressure elevation and other health hazards found in a large-scale population survey. J Intern Med. 1992 Oct;232(4):327–334. [PubMed]
  • Russell MA, Jarvis MJ, Devitt G, Feyerabend C. Nicotine intake by snuff users. Br Med J (Clin Res Ed) 1981 Sep 26;283(6295):814–817. [PMC free article] [PubMed]
  • Greenland S, Robins JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics. 1985 Mar;41(1):55–68. [PubMed]
  • Huhtasaari F, Asplund K, Lundberg V, Stegmayr B, Wester PO. Tobacco and myocardial infarction: is snuff less dangerous than cigarettes? BMJ. 1992 Nov 21;305(6864):1252–1256. [PMC free article] [PubMed]
  • Wall S, Rosén M, Nyström L. The Swedish mortality pattern: a basis for health planning? Int J Epidemiol. 1985 Jun;14(2):285–292. [PubMed]
  • de Faire U, Friberg L, Lorich U, Lundman T. A validation of cause-of-death certification in 1,156 deaths. Acta Med Scand. 1976;200(3):223–228. [PubMed]
  • Siegel D, Benowitz N, Ernster VL, Grady DG, Hauck WW. Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players. Am J Public Health. 1992 Mar;82(3):417–421. [PMC free article] [PubMed]
  • Eliasson M, Lundblad D, Hägg E. Cardiovascular risk factors in young snuff-users and cigarette smokers. J Intern Med. 1991 Jul;230(1):17–22. [PubMed]
  • Tucker LA. Use of smokeless tobacco, cigarette smoking, and hypercholesterolemia. Am J Public Health. 1989 Aug;79(8):1048–1050. [PMC free article] [PubMed]
  • Gyntelberg F, Meyer J. Relationship between blood pressure and physical fitness, smoking and alcohol consumption in Copenhagen males aged 40-59. Acta Med Scand. 1974 May;195(5):375–380. [PubMed]
  • Friedman LA, Kimball AW. Coronary heart disease mortality and alcohol consumption in Framingham. Am J Epidemiol. 1986 Sep;124(3):481–489. [PubMed]
  • Moore RD, Pearson TA. Moderate alcohol consumption and coronary artery disease. A review. Medicine (Baltimore) 1986 Jul;65(4):242–267. [PubMed]
  • Seltzer CC. Effect of smoking on blood pressure. Am Heart J. 1974 May;87(5):558–564. [PubMed]
  • Benowitz NL. Clinical pharmacology of nicotine. Annu Rev Med. 1986;37:21–32. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • Compound
    PubChem Compound links
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...