The Association Between Snus Use and Cardiovascular Health, Metabolism, and Mental Health Based on SCAPIS 1 & 2

Historically, snus use in Sweden was very stable, primarily used by about 20% of men and only 4-5% of women. However, the recent introduction of "white snus" (nicotine pouches) has dramatically changed this landscape. Today, women are using snus at nearly the same rate as men, with the sharpest increase seen among young people.

Globally, snus is gaining massive popularity and is heavily marketed by major tobacco companies as a safe alternative to smoking cigarettes. But is it really safe?

Current research shows a mixed picture. Some studies suggest that snus users have stiffer arteries and face a higher risk of death if they suffer a heart attack or stroke. In fact, quitting snus after a heart attack can cut the risk of mortality in half. Conversely, other studies have found no clear link between snus and heart disease. Because of these scattered and confusing results, more comprehensive research is urgently needed.

What is the study trying to find out? The primary goal of this research is to see if using snus-completely independent of smoking cigarettes-is linked to negative health outcomes. The researchers have a strong hypothesis: they believe snus use may be associated with increased artery damage, higher blood pressure, poorer metabolic health, and higher stress levels.

Specifically, the study will investigate if snus use is connected to:

Heart and Blood Vessel Health: Is snus linked to a higher buildup of plaque in the coronary arteries (atherosclerosis), which can lead to heart attacks?

Metabolic Health: Does snus negatively affect cardiometabolic markers, such as cholesterol levels, blood sugar, body weight, waist circumference, and blood pressure?

Mental Well-being: Is there a connection between snus use and psychological distress, poor sleep, high stress levels, or increased sick leave?

How will the study be conducted?

To get the most accurate answers, the researchers are using data from SCAPIS (the Swedish Cardiopulmonary Bioimage Study), a massive, high-quality health study.

Following People Over Time: The researchers will look at data from two different time points: "SCAPIS 1" (the baseline) and "SCAPIS 2" (the follow-up). This allows them not only to take a snapshot of people's health but also to track how their health changes over time.

Comparing Different Groups: The study will compare people who have never used snus, former users, and current users. It will also look at how much snus people use, how long they have used it, and whether they use traditional tobacco snus or the newer white nicotine pouches.

Advanced Medical Testing: The study relies on thorough medical data, including advanced CT scans of the heart to look for plaque, detailed blood tests for cholesterol and inflammation, and comprehensive questionnaires regarding mental health and stress.

Importantly, the researchers will use advanced statistics to ensure that other lifestyle factors-like diet, exercise, alcohol use, and a history of smoking-do not skew the results. This ensures they are isolating the specific effects of snus.