[Use of snuff entails lower risk of cardiovascular diseases than does smoking]

Oral snuff, a form of smokeless tobacco, causes an immediate rise in heart rate and blood pressure, but snuff users do not show permanent changes in heart rate or blood pressure when not exposed to tobacco. Cardiac output during workload and maximal work capacity are unaffected. Snuff users usually do not show the biochemical stigmata that regular smokers do with the exception of a possible excess risk of type 2 diabetes. Two studies have found that snuff users, as opposed to smokers, do not show increased intima-media thickness or atherosclerotic lesions when investigated by ultrasonography. Results on the risk of myocardial infarction have provided conflicting evidence, two case-control studies showing the same risk as in non-tobacco users and one cohort study showing an increased risk of cardiovascular death. A nested case-control study failed to show an excess risk of stroke in snuff users. It is concluded that the use of smokeless tobacco (with snuff being the most studied variant) entails a lower risk of adverse cardiovascular effects than does smoking.