| Titre : | Circulatory disease and smokeless tobacco in Western populations : a review of the evidence. Commentary. (2007) |
| Auteurs : | LEE (Peter-N) : GBR. Statistics and Computing Ltd. Sutton Surrey. ; Anna GILMORE, disc. ; Martin McKee, disc. |
| Type de document : | Article |
| Dans : | International journal of epidemiology (vol. 36, n° 4, 2007) |
| Pagination : | 789-808 |
| Langues: | Anglais |
| Mots-clés : | Cardiopathie ; Facteur risque ; Epidémiologie ; Vaisseau sanguin encéphale [pathologie] ; Tabac sans fumée ; Suède ; Diabète ; Etats Unis ; Homme ; Hypertension artérielle ; Tabagisme ; Europe ; Amérique ; Appareil circulatoire [pathologie] ; Système nerveux [pathologie] ; Glande endocrine [pathologie] ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST-CNRS YGR0xiWD. Diffusion soumise à autorisation]. 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 dose-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. |
Service Documentation EHESP
Me connecter
PORTAIL DOCUMENTAIRE
École des hautes études en santé publique
Catalogue
Multi-bases
Accueil
Sélection de la langue
Adresse
Service Documentation EHESPBibliothèque Rennes Avenue du Professeur Léon Bernard – CS 74312 – 35043 Rennes Cedex Bibliothèque MSSH Paris 20 avenue George Sand - 93210 La Plaine Saint-Denis
France
Bibliothèque Rennes : 02 99 02 29 50 Bibliothèque MSSH Paris : 02 99 02 24 50
contact