Smoking, Menthol Cigarettes and All-Cause, Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition Examination Survey (NHANES) and a Meta-Analysis

Abstract

BackgroundThe U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including menthol, if the scientific evidence indicates harm. Few studies, however, have evaluated the health effects of menthol cigarette use.ObjectiveTo investigate associations of cigarette smoking and menthol cigarette use with all-cause, cancer and cardiovascular risk in U.S. adults.MethodsWe studied 10,289 adults ≥ 20 years of age who participated in the National Health and Nutrition Examination Survey from 1999-2004 and were followed through December 2006. We also identified studies comparing risk of all-cause mortality, cardiovascular disease and cancer for menthol and nonmenthol cigarette smokers and estimates were pooled using random-effects models.ResultsFifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The adjusted hazard ratios (95% CI) for former, current nonmenthol and current menthol cigarette smokers compared to never smokers were 1.24 (0.96, 1.62), 2.40 (1.56, 3.71) and 2.07 (1.20, 3.58), respectively, for all-cause mortality; 0.92 (0.62, 1.37), 2.10 (1.02, 4.31) and 3.48 (1.52, 7.99) for cardiovascular mortality; and 1.91 (1.21, 3.00), 3.82 (2.19, 6.68) and 2.03 (1.00, 4.13) for cancer mortality. Using data from 3 studies of all-cause mortality, 5 of cardiovascular disease and 13 of cancer, the pooled relative risks (95% CI) comparing menthol cigarette smokers to nonmenthol cigarette smokers was 0.94 (0.85, 1.05) for all-cause mortality, 1.28 (0.91, 1.80) for cardiovascular disease and 0.84 (0.76, 0.92) for any cancer.ConclusionsIn a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes. In the systematic review, menthol cigarette use was associated with inverse risk of cancer compared to nonmenthol cigarette use with some evidence of an increased risk for cardiovascular disease.

Factors Associated with Cancer- and Non-Cancer-Related Deaths among Taiwanese Patients with Diabetes after 17 Years of Follow-Up

“…In the present study, hypertension is consistently predictive for non-cancer death (Models I to III, Table 4), but not for cancer death in the model considering additional adjustment for fasting glucose and history of dyslipidemia (Model III of Table 4). Smoking has been well recognized as an important risk factor for the mortality from a variety of cancer and cardiovascular disease [37]. This is similarly observed for either cancer or non-cancer death (Models I to III, Table 4).…”

Measures of dependence in menthol and nonmenthol smokers - A comprehensive narrative review

“…While some researchers have focused on the TTFC 5 minutes comparisons, the TTFC >60 minutes comparison is an equally important predictor of cessation outcomes. 140 Of the dozens of analyses available, and in particular those with adjusted analyses and large or representative samples, most report no difference. Both longer and shorter TTFC among menthol compared to nonmenthol smokers are also reported.…”

Associations of evolutionary-concordance diet, Mediterranean diet and evolutionary-concordance lifestyle pattern scores with all-cause and cause-specific mortality

“…First, because there were only three categories for each lifestyle variable (rather than five categories as for the dietary variables), to put the lifestyle variables on the same initial scale as the dietary variables, each component was assigned a preliminary score of 1, 3, or 5, for, respectively, low/medium/high physical activity, BMI ≥30/25-<30/<25 kg/m 2 , and current/ former/never smoking. Then, because the individual lifestyle factors are more strongly associated with all-cause, CVD, and cancer mortality than are the individual dietary factors, the preliminary scores were weighted by dividing the two "most exposed" category scores by summary relative risks from meta-analyses of associations of physical activity (21,22,25) , BMI (23) , and smoking status (19,20,24) with all-cause, CVD, and cancer mortality. The summary relative risk values from these meta-analyses that were used for weighting the lifestyle score components are shown in Table 2.…”

“…Various diet patterns, which contain multiple constituents, acting and interacting along the same and different pathways, have been inversely associated with chronic disease risk and mortality (7,8,9,10,11,12,13,14,15,16,17) , supporting further research into dietary patterns in chronic disease prevention (18) . Physical activity, excess adiposity, smoking, and other modifiable lifestyle factors have been associated with higher mortality (3,19,20,21,22,23,24,25) . Lifestyle factors coexist and may interact, and underlying causes of death may be multi-causal (5) , suggesting that investigating associations of various lifestyle factors, in combination, with mortality may help with developing public health recommendations (3,4,5,8,26,27,28,29) .…”