Circulatory disease and smokeless tobacco in Western populations: a review of the evidence
Circulatory disease and smokeless tobacco in Western populations: a review of the evidence
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DOI：
10.1093/ije/dym039
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发表时间：
2007-08-01
影响因子：
7.7
通讯作者：
Lee, Peter N.
中科院分区：
文献类型：
--
作者：
Lee, Peter N.
背景：在瑞典，口腔鼻烟或“鼻烟”的使用有所增加。鼻烟在美国的销量也有所上升，超过了咀嚼烟草的销量。有一些证据表明，尼古丁会导致吸烟引起的循环系统疾病。因此，我们回顾了无烟烟草(ST)与CID和相关危险因素相关的证据。方法从内部档案、2005年12月的Medline检索和参考文献列表中确定描述相关队列、病例对照和横断面研究的出版物。根据吸烟习惯对缺血性心脏病、中风和所有使用ST的CID的相对危险度(RR)和优势比(OR)进行评估，并通过荟萃分析进行组合，以提供总体RR估计。结果非吸烟者使用ST与心脏病(RR 1.12，95%CI 0.99~1.27，n=8)、中风(1.42，1.29~1.57，n=5)和CID(1.25，1.14~1.37，n=3)的风险增加相关。这一增长主要来自美国的两项大型研究。瑞典的研究几乎没有提供心脏病(1.06，0.83-1.37，n=5)或中风(1.17，0.80-1.70，n=2)增加的证据，尽管按国家进行的估计并不明显不同，即使是中风(P=0.29)。没有明显的亲密反应。在曾经吸食ST的人中，或在也吸烟的ST使用者中，没有看到增加。没有发现与糖尿病有明确的关系。在美国，使用ST后的急性血压升高一直被报道，个别报告将特定的危险因素与ST联系在一起。在瑞典，尽管一项研究报告说鼻烟会显著增加血压，还有两项研究将鼻烟与雷诺型症状联系起来，但总体上证明这种效果的证据并不确定。瑞典的研究总体上没有显示鼻烟对血压或各种危险因素的慢性影响。结论任何来自ST的CID风险似乎都大大低于吸烟，瑞典鼻烟没有明显的风险。然而，总体证据有限。
Background Use of oral snuff or 'snus' has risen in Sweden. Sales of snuff in the US have also risen, overtaking sales of chewing tobacco. There is some evidence that nicotine contributes to circulatory disease (CID) from smoking. We therefore reviewed the evidence relating smokeless tobacco (ST) to CID and related risk factors.Methods Publications that described relevant cohort, case-control and cross-sectional studies were identified from in-house files, a Medline search in December 2005 and reference lists. Relative risks (RRs) and odds ratios (ORs) for ischaemic heart disease, stroke and all CID for ST use, stratified by smoking habit, were estimated and combined by meta-analysis to provide an overall RR estimate. For diabetes, increased blood pressure, and other risk factors, evidence was qualitatively reviewed, with results from clinical studies also considered.Results ST use in non-smokers was associated with an increased risk of heart disease (RR 1.12, 95% CI 0.99-1.27, n=8), stroke (1.42, 1.29-1.57, n=5) and CID (1.25, 1.14-1.37, n = 3). The increases mainly derived from two large US studies. The Swedish studies provided little evidence of an increase for heart disease (1.06, 0.83-1.37, n=5) or stroke (1.17, 0.80-1.70, n=2), although the estimates by country are not notably heterogeneous, even for stroke (P = 0.29). No close-response was evident. No increase was seen in former users of ST, or in ST users who also smoked. No clear relationship to diabetes was seen. In the US, an acute blood pressure rise following ST use was consistently reported, and isolated reports linked specific risk factors to ST. In Sweden, though one study reported that snuff acutely increased blood pressure, and two linked snuff to Raynaud-type symptoms, the overall evidence for an effect was inconclusive. Swedish studies generally showed no chronic effect of snuff on blood pressure or various risk factors.Conclusions Any CID risk from ST appears to be substantially less than from smoking, and no clear risk from Swedish snuff is seen. However, the overall evidence is limited.