Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2014 Jul;276(1):87-95. doi: 10.1111/joim.12219. Epub 2014 Mar 29.
Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear.
The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes.
Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods, respectively.
No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92-1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28-day case fatality was 1.42 (95% CI 0.99-2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow-up period was 1.32 (95% CI 1.08-1.61).
Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms.
鼻烟是一种含有高尼古丁的湿无烟烟草制品。它对心血管系统有短期影响，但鼻烟使用与中风之间的关系尚不清楚。
本研究旨在评估鼻烟使用与中风的发病和发病后生存之间的关系，包括整体和根据亚型的关系。
对 8 项瑞典前瞻性队列研究进行了汇总分析，包括 130485 名从不吸烟的男性。我们使用 Cox 比例风险回归模型估计了发病率和诊断后死亡率的风险比（HRs），使用逻辑回归和 Kaplan-Meier 方法分别估计了病死率和生存率。
鼻烟使用与总体中风风险（HR 1.04，95%CI 0.92-1.17）或任何中风亚型风险之间均无关联。经历过中风的鼻烟使用者 28 天病死率的比值比（OR）为 1.42（95%CI 0.99-2.04），随访期间死亡率的 HR 为 1.32（95%CI 1.08-1.61）。
鼻烟使用与中风风险无关。因此，尼古丁不太可能对中风的病理生理学有重要贡献。然而，与不使用者相比，鼻烟使用者的病死率增加，但需要进一步研究以确定任何可能的因果机制。
