RELATIONSHIP OF CIGARETTE-SMOKING AND SNUFF DIPPING TO PLASMA-FIBRINOGEN, FIBRINOLYTIC VARIABLES AND SERUM-INSULIN - THE NORTHERN SWEDEN MONICA STUDY

The influence of cigarette smoking and use of smokeless tobacco on pla sma fibrinogen level, fibrinolytic variables, glucose tolerance and se rum insulin was studied in a randomly selected population sample consi sting of 604 men and 662 females between 25 and 64 years. Subjects wer e grouped according to tobacco habits as follows: regular smokers (> 1 cig/day), ex-smokers, snuff dippers, and non-tobacco users. An oral g lucose tolerance test was performed on 54% of the participants, Tissue plasminogen activator (tPA) activity and plasminogen activator inhibi tor type 1 (PAI-I) activity were used to study fibrinolysis. Men who s moked had 0.34 g/l (95% CI 0.17 to 0.49) higher fibrinogen level than non-tobacco users and numbers of cigarettes smoked correlated with pla sma fibrinogen levels (r = 0.21, P = 0.006). Female smokers had signif icantly higher fibrinogen levels than ex-smokers but the difference co mpared with non-smokers was not significant, Snuff dipping did not aff ect fibrinogen levels. We found no relationship between tPA activity, PAI-I activity and tobacco use, Post-load plasma glucose was lower in women who smoked, otherwise no influence of tobacco use on glucose lev els was seen. Lower post-load insulin levels (-8.8 mU/ml, 95% CI -2.4 to -16.3) than in non-smokers were also found in women who smoked. Thi s was only partially explained by a lower body mass index in smokers. We conclude that cigarette smoking is associated with increased fibrin ogen levels, unaltered fibrinolysis, normal glucose tolerance and insu lin levels. The use of smokeless tobacco, as moist oral snuff, does no t appear to affect these potential cardiovascular risk factors.