Cardiovascular and metabolic changes following 12 weeks of tobacco and nicotine pouch cessation: a Swedish cohort study

OBJECTIVES: Use of snus, including tobacco and nicotine pouches, is increasing in many countries. Nicotine increases blood pressure (BP) acutely, but the long-term effects of quitting the regular use of snus pouches are unknown. The aim was to evaluate the effects of snus cessation on home BP and markers of the metabolic syndrome. METHODS: Volunteers aged 18-70 years using snus daily were invited to abruptly end their snus intake and followed using home BP and metabolic measurements before and for 12 weeks after cessation. RESULTS: Fifty volunteers were recruited. Of these, 46 (92%) attempted snus cessation and 37 (74%) did not use snus for at least 3 weeks and were included in the study. Of those included, 33 maintained snus cessation for all 12 weeks. The mean age was 38 (± 10) years and 24 (65%) were men. At week 12, the mean changes in systolic home BP was 3.7 (95% CI 1.5-5.9) mmHg, in body weight was 1.8 (95% CI 1.1-2.4) kg, and in HbA1c was 0.7 (95% CI 0.0-1.6) mmol/mol. CONCLUSIONS: Cessation of tobacco and nicotine pouches in individuals who regularly used snus negatively impacted systolic home BP, body weight and HbA1c after 12 weeks. Whether these effects would be reversed by snus re-initiation cannot be determined by this study, but our novel findings suggest that successful cessation of regular snus usage does not immediate improve these cardiovascular risk factors. We call for further research to confirm our findings and evaluate the effects over longer time frames. CLINICAL TRIAL REGISTRY NUMBER: NCT06019910, https://clinicaltrials.gov/study/NCT06019910 .