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Research Letter
Apr 9, 2012

Mentholated Cigarettes and Cardiovascular and Pulmonary Diseases: A Population-Based Study

Author Affiliations

Author Affiliations: Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, and Division of Internal Medicine, Department of Medicine, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada.

Arch Intern Med. 2012;172(7):590-593. doi:10.1001/archinternmed.2012.320

Cigarettes labeled as “mentholated” contain substantially higher levels of menthol than regular cigarettes, to produce a characteristic mint flavor and cooling sensation. Potential noncancer adverse health effects of added menthol to cigarettes are largely unknown. Epidemiologic data on the risks of cardiovascular and pulmonary diseases among smokers of mentholated vs nonmentholated cigarettes are extremely limited.1,2 The purpose of this study was to determine if cardiovascular and pulmonary disease risk was different between mentholated cigarette smokers and nonmentholated cigarette smokers.

A multiyear, cross-sectional, population-based design was used. A total of 5167 current smokers at least 20 years old from the 2001-2008 US National Health and Nutrition Examination Surveys (NHANES)3 formed the study group. Mentholation status of the cigarettes “usually” smoked was ascertained for 5028 individuals (97.3%). For 3791 individuals (75.4%), cigarette mentholation status was determined by survey administrator examination of smokers' usual cigarette packages. For 1237 individuals (24.6%), cigarette mentholation status was determined by asking participants whether cigarettes they usually smoked were mentholated. Health professional–diagnosed, self-reported hypertension, myocardial infarction, congestive heart failure, stroke, and chronic obstructive pulmonary disease (COPD) were the outcomes examined. Descriptive statistics and multiple logistic regression were use to examine the association between mentholated cigarette smoking and cardiovascular and pulmonary diseases. Given previously reported sex,3,4 race,3,5 and age group3 discrepancies between mentholated and nonmentholated cigarette smokers, fully stratified analyses by sex (women vs men), race (African Americans vs non–African Americans), and age group (≥70 years vs < 70 years) were performed to look for potential differences in outcomes among subgroups of interest. To account for the complex sampling design of NHANES, all point estimates were appropriately weighted, and variance estimates were adjusted by Taylor linearization procedures.