Smokeless Tobacco and the Risk of Stroke
Smokeless Tobacco and the Risk of Stroke
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DOI：
10.1097/ede.0b013e3181878b33
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发表时间：
2008-11-01
期刊：
影响因子：
5.4
通讯作者：
Ye, Weimin
中科院分区：
文献类型：
--
作者：
Hergens, Maria-Pia;Lambe, Mats;Ye, Weimin
背景：在瑞典，使用无烟烟草(口腔湿润鼻烟)在成年男性中很常见。关于长期使用鼻烟对脑血管影响的研究有限，也没有定论。我们的目的是研究长期使用鼻烟是否会影响中风的风险。方法：对1978年至1993年参加健康体检的瑞典建筑工人进行问卷调查，收集烟草使用信息。总共有118,465名从不吸烟、没有中风病史的男性在2003年接受了跟踪调查。我们使用住院登记和死亡原因登记来确定卒中及其亚型(缺血性、出血性和不明原因卒中)的后续发病率和死亡率。结果：近30%的不吸烟男性吸食过鼻烟。总体而言，在随访期间发现了3248例中风病例。与非吸烟者相比，吸烟者的多变量调整后的相对危险度为1.02(95%可信区间；0.92~1.13)，死亡病例为1.27(0.92~1.76)。对卒中亚型的进一步分析显示，与当前鼻烟使用有关的致命性缺血性中风的风险增加(1.72；1.06-2.78)，而出血性中风的风险没有增加。结论：使用鼻烟可能会增加致命性中风，尤其是致命性缺血性中风的风险。
Background: In Sweden, use of smokeless tobacco (oral moist snuff) is common among adult men. Research on cerebrovascular effects associated with long-term use of snuff is limited and inconclusive. We aimed to study whether long-term use of snuff affects the risk of stroke.Methods: Information on tobacco use was collected by questionnaire among Swedish construction workers attending health checkups between 1978 and 1993. In total, 118,465 never-smoking men without a history of stroke were followed through 2003. We used the Inpatient Register and Causes of Death Register to identify subsequent morbidity and mortality from stroke and its subtypes (ischemic, hemorrhagic, and unspecified stroke). Relative risk estimates were derived from Cox proportional hazards regression model.Results: Almost 30% of the nonsmoking men had ever used snuff. Overall, 3248 cases of stroke were identified during follow-up. Compared with nonusers of tobacco, the multivariable-adjusted relative risks for ever-users of snuff were 1.02 (95% confidence interval; 0.92-1.13) for all cases and 1.27 (0.92-1.76) for fatal cases. Further analyses on subtypes of stroke revealed an increased risk of fatal ischemic stroke associated with current snuff use (1.72; 1.06-2.78), whereas no increased risk was noted for hemorrhagic stroke.Conclusion: Snuff use may elevate the risk of fatal stroke, and particularly of fatal ischemic stroke.