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Snus use and cardiovascular risk factors in the general population: the HUNT3 study

Authors

  • Simon Øverland,

    Corresponding author
    1. Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
    2. Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    3. Division of Mental Health, National Institute of Public Health, Bergen, Norway
    • Correspondence to: Simon Øverland, Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Christiesgate 13, 5015 Bergen, Norway. E-mail: Simon.overland@uib.no

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  • Jens Christoffer Skogen,

    1. Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
    2. Division of Mental Health, National Institute of Public Health, Bergen, Norway
    3. Alcohol And Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
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  • Lauren Lissner,

    1. Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Ottar Bjerkeset,

    1. Department of Research and Development (R&D), Levanger Hospital, Levanger, Norway
    2. Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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  • Tore Tjora,

    1. Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
    2. Division of Mental Health, National Institute of Public Health, Bergen, Norway
    3. Uni Health, University of Bergen, Bergen, Norway
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  • Robert Stewart

    1. Institute of Psychiatry, King's College London, London, UK
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Abstract

Background and aims

Snus, a form of smokeless tobacco, is increasingly popular in its traditional Nordic markets, and was recently launched commercially in the United States. We examined the cross-sectional associations between snus use and cardiovascular risk factors, and compared them with the corresponding associations of smoking.

Design

Cross-sectional study.

Setting

The HUNT3 general population survey, Nord-Trøndelag, Norway (2006–08).

Participants

A general population sample of n = 25 163.

Measurements

Measured triglyceride,- glucose- and high-density lipoprotein (HDL)-cholesterol levels, blood pressure and waist circumference, registry information on gender, age and education level, self-reported snus use, smoking, physical exercise and alcohol use.

Findings

In age- and gender-adjusted linear regression analyses, extensive snus use was associated with larger waist circumference (b = 1.65, 95% CI = 0.86, 2.43) and higher systolic blood pressure (b = 2.58, 95% CI = 1.48, 3.68), but with higher rather than lower levels of HDL-cholesterol (b = 1.66, 95% CI = 0.79, 2.53). These three differences remained significant after additional adjustment for smoking, education level, physical exercise and alcohol use. Smokers had higher triglyceride and lower HDL-cholesterol than snus users, but lower systolic blood pressure.

Conclusions

After adjusting statistically for major confounding variables, Norwegians who use snus extensively have a mixed profile in terms of cardiovascular risk: slightly higher waist circumference and systolic blood pressure but also higher high-density lipoprotein-cholesterol.

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