SMOKELESS TOBACCO USE AND INCREASED CARDIOVASCULAR MORTALITY AMONG SWEDISH CONSTRUCTION WORKERS

Objectives. Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nic otine levels similar to those caused by cigarette smoking. Methods. Ma le Swedish construction industry employees (n = 135 036) who attended a health examination were followed by studying cause-specific mortalit y during a 12-year period. The study population comprised 6297 smokele ss tobacco users, 14 983 smokers of fewer than 15 cigarettes per day, 13 518 smokers of 15 or more cigarettes per day, 17 437 ex-smokers, 50 255 ''other' tobacco users, and 32 546 nonusers. Results. The age-adj usted relative risk of dying from cardiovascular disease was 1.4 for s mokeless tobacco users and 1.9 for smokers of 15 or more cigarettes pe r day, compared with nonusers. Among men aged 35 through 54 years at t he start of follow-up, the relative risk was 2.1 for smokeless tobacco users and 3.2 for smokers. When data were adjusted for body mass inde x, blood pressure, and history of heart symptoms, the results were ess entially unchanged. Cancer mortality was not raised in smokeless tobac co users. Conclusions. Both smokeless tobacco users and smokers face a higher risk of dying from cardiovascular disease than nonusers. Altho ugh the risk is lower for smokeless tobacco users than for smokers, th e excess risk gives cause preventive actions.