Quitting smokeless tobacco after a heart attack halved the death risk for patients in a recent study from Sweden, similar to the known benefits of smoking cessation. The study, published in the journal Circulation, should disabuse users of the idea that smokeless tobacco provides a safe alternative to smoking.

Lead researcher Gabriel Arefalk and his colleagues followed the outcomes of 675 patients who had quit smokeless tobacco after suffering a myocardial infarction, along with another 1,799 patients who continued to use snuff. After a couple of years, the expected death rate among patients who had quit smokeless tobacco had fallen by half compared to the others, dropping from 18.7 to 9.7 per 1,000 person-years. With all risk factors considered, the “hazard ratio” for quitters was 0.57, or approximately half the death risk otherwise incurred prior to quitting smokeless tobacco. According to Arefalk, that rate compares nicely to the 0.54 hazard ratio for patients who quit smoking after a heart attack.

“We didn’t expect to see such a strong association among those people who stopped using [smokeless tobacco],” lead researcher Gabriel Arefalk, said in a press statement. “After a heart attack, no doubt smoking cessation reduces the risk of death approximately one-third and is really a cornerstone of cardiac rehabilitation worldwide. For smokeless tobacco, we did not know.”

Yet aside from this heightened death risk after heart attack, smokeless tobacco is known to cause cancers of the oral cavity, esophagus, and pancreas. Approximately 3 percent of working-age Americans used smokeless tobacco products between 2005 and 20010, according to the Centers for Disease Control and Prevention (CDC). No significant change in usage rates was seen during those years as smokeless tobacco use rose from 2.7 percent to 3 percent. Smokeless tobacco products were more popular among certain demographics, including younger working age adults (3.9 percent), men (5.6 percent), Southerners (3.9 percent), non-Hispanic whites (4 percent), and those with no more than a high school education (3.9 percent).

By 2010, use of smokeless tobacco products was highest among construction and trade workers at 10.8 percent, with workers in installation, maintenance, and repair reporting a 9 percent usage rate. Interestingly, the CDC found that while many health care workers may smoke cigarettes, the prevalence of smokeless tobacco among clinicians and support staff was practically nil.

Source: Arefalk, Gabriel, Hambraeus, Kristina, Lind, Lars, et al. Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation. 2014.

Below is a video from the CDC on the risks of smokeless tobacco: