"Any adverse effect of cigars on coronary heart disease is of particular importance given the recent rise in the prevalence of cigar smoking in the United States," says lead author Eric J. Jacobs, Ph.D., an epidemiologist with the American Cancer Society’s Department of Epidemiology and Surveillance Research.

The research team evaluated data from more than 121,000 men aged 30 years or old who identified themselves as "current cigar smokers" when they enrolled in the American Cancer Society’s Cancer Prevention Study II in 1982. The men reported never having smoked cigarettes or pipes, nor having been diagnosed with heart disease or diabetes. By 1991, more than 2,500 of these men had died from coronary heart disease.

"Although statistical power was limited, stronger increases in risk were observed for men who smoked 2 or more cigars per day, had smoked for 25 years or more, or had reported inhaling while smoking cigars," the authors write. However, the authors note that, "Even relatively low-dose exposures could plausibly increase coronary heart disease mortality."

The authors also report that it is biologically plausible that cigar smoking increases risk of coronary heart disease because tobacco smoke from cigars is chemically similar to cigarette smoke, a known cause of heart disease. According to the authors, while cigar smokers are much less likely to report inhaling tobacco smoke than cigarette smokers, they may nevertheless inhale substantial amounts of tobacco smoke from their own cigars because cigars produce high levels of environmental tobacco smoke. The study is one of only a few in which the cigar-heart disease relationship is addressed, and is based on much more recent data than previous large studies which were based primarily on data from the 1950s and 1960s. The current study represents the only investigation in which researchers evaluated only men who had no heart disease or diabetes at the start of the study; this is important because some high-risk men who develop heart disease may quit smoking cigars, thereby partially obscuring the effect of cigar smoking on death from heart disease. This study also is the first in which researchers took into account a number of factors such as alcohol use, obesity and educational status, that could have biased results from earlier studies.

The authors cited statistics estimating that the number of cigars consumed in the United States increased by nearly 50 percent between 1993 and 1996.

"This rapid increase is particularly striking because it followed a 66 percent decline from 1964 to 1992," they report. Despite some predictions that the cigar "craze" may be winding down, the most recent report from the U.S. Department of Agriculture show increased cigar consumption in 1998 — the most recent year for which data is available. Data from the 1997 Youth Risk Behavior Survey also points to the importance of cigar smoking as a potential emerging public health hazard, the authors write. That survey showed 31 percent of U.S. high school boys and 11 percent of high school girls had reported smoking a cigar within the past 30 days.

Co-authors include Michael J. Thun, M.D., and Louis F. Apicella, M.S.P.H., also of the American Cancer Society’s Department of Epidemiology and Surveillance Research.

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Joann Schellenbach

American Cancer Society
2123822169
jschelle@cancer.org