Smokeless Tobacco Use Is Associated with Fatal MI and Stroke

The growing popularity of smokeless tobacco products in recent years could be fueled by claims that these products are safer than cigarettes and cigars. Nevertheless, smokeless tobacco is carcinogenic, and prior research suggests that it is associated with elevated risk for adverse cardiovascular events. In this meta-analysis of 11 observational studies (8 from Sweden and 3 from the U.S.), investigators assessed whether users of smokeless tobacco were at elevated risk for myocardial infarction and stroke.

Nine studies were restricted to never-smokers, and two studies involved former smokers. Compared with nonusers, ever-users of smokeless tobacco products faced significantly elevated risk for fatal MI (relative risk, 1.13), along with excess…