AbstractOBJECTIVE To estimate the risk of myocardial infarction in snuff users, cigarette smokers, and non tobacco users in northern Sweden, where using snuff is traditional. DESIGN Case control study. SETTING Northern Sweden. SUBJECTS All 35 64 year old men who had had a first myocardial infarction and a population based sample of 35 64 year old men who had not had an infarction in the same geographical area. https://www.riversidecontin.co.uk MAIN OUTCOME MEASURE Tobacco consumption (regular snuff dipping, regular cigarette smoking, non tobacco use) and risk of acute myocardial infarction. RESULTS 59 of 585 (10%) patients who had a first myocardial infarction and 87 of 589 (15%) randomly selected men without myocardial infarction were non smokers who used snuff daily. The age adjusted odds ratio for myocardial infarction was 0.89 https://www.riversidecontin.co.uk (95% confidence interval 0.62 to 1.29) for exposure to snuff and 1.87 (1.40 to 2.48) for cigarette smoking compared with non tobacco users, showing an increased risk in smokers but not in snuff dippers. Regular cigarette smokers had a significantly higher risk of myocardial infarction than regular snuff dippers (age adjusted odds ratio 2.09; 1.39 to 3.15). Smoking, but not snuff dipping, predicted myocardial infarction in a multiple logistic regression model that included age and level of education. CONCLUSIONS In middle aged men snuff dipping is associated with a lower risk of myocardial infarction than cigarette smoking.
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