Quitting Smokeless Tobacco Extends Life Expectancy Post-Heart Attack

Ceasing to use smokeless tobacco after a heart attack may help extend patients’ life expectancy in a way similar to those who stop smoking, according to new research.

In what may be the first study to examine the effect of smokeless tobacco on death in heart attack survivors, investigators from Uppsala University Hospital in Uppsala, Sweden analyzed the effect of quitting the use of snus, a moist Swedish smokeless powder tobacco.
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The authors reviewed data on heart-attack survivors under the age of 75 in Sweden between the years of 2005 and 2009, identifying 2,474 snus users. Among them, 675 quit using snus during this time. During 2 years of follow-up, 14 participants who had quit using snus died, in comparison to 69 of those who continued using snus. By using a mathematical analysis estimating the number of people who die in 1,000 years, the researchers determined that the death rate was 9.7 per 1,000 person-years for snus quitters, while the death rate was 18.7 for snus users.

After taking into consideration factors such as age, gender, other tobacco use, occupation, and participation in a cardiac rehabilitation program, the authors said that those who had stopped using snus were at nearly half the mortality risk of those who continued using snus. This decreased risk, they said, is similar to that observed among heart-attack survivors who stop smoking.  

“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,” says Gabriel Arefalk, MD, a cardiologist at Uppsala University Hospital, and the study’s lead researcher, in a statement.

“The risk of dying during follow-up was almost halved among those who quit either tobacco form, compared to those that continued. Therefore, if you have established coronary heart disease, my recommendation would be to discourage both the use of cigarettes and smokeless tobacco.”

Another important finding was the discovery that only about 30 percent of the snus users, and 60 percent of the smokers actually did quit after their myocardial infarction,” continues Arefalk.

“There is a great need for improvement in offering post-MI patients a safe and effective way to [achieve] tobacco abstinence, and primary care physicians are of crucial importance, if this task is ever to be successful.”

Nevertheless, “one should always be careful about claiming causality when it comes to observational studies such as this one,” adds Arefalk. “Ideally, the effects of quitting snus after a myocardial infarction should be studied in a randomized clinical trial. Although there is a need for confirmatory studies, this is the only evidence available so far, and I think patients should be informed and advised according to the results.”

—Mark McGraw

Reference

Arefalk G, Hambraeus K, et al. Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation. 2014.