April 18, 2012 — Menthol cigarettes more than double the risk for
stroke compared with regular cigarettes, a new study shows. In women and
nonblack smokers, the risk for stroke was more than tripled.
No significant associations were observed between the tobacco
additive and other forms of cardiovascular disease, such as
hypertension, myocardial infarction, congestive heart failure, and
chronic obstructive pulmonary disease (COPD).
The mechanism by which menthol may increase stroke risk remains unclear.
One potential mechanism is that menthol stimulates upper-airway cold
receptors, which can increase breath-holding time, which may in turn
facilitate the entrance of cigarette particulate matter into the lungs,
notes Nicholas Vozoris, MD, from St. Michael's Hospital, in Toronto,
Ontario, Canada.
Another possibility is that menthol cigarettes exert some selective effects on the cerebrovascular system.
"[S]moking mentholated cigarettes has been found to result in
increased carotid artery stiffness compared with smoking nonmentholated
cigarettes, whereas equal decreases in coronary artery reserve flow were
observed between the 2 cigarette types," Dr. Vosoris explains.
The study is published in the April 9 issue of Archives of Internal Medicine.
Menthol Cigarettes Linked to Increased Stroke Risk
For the study, Dr. Vosoris obtained data for 5028 current smokers
aged 20 years and older by using the 2001-2008 US National Health and
Nutrition Examination Survey (NHANES); 1286 individuals (25.6%) usually
smoked menthol cigarettes and 3742 (74.4%) smoked other types. Given
previously reported differences in effect by age, sex, and age group,
fully stratified analyses looking specifically at these subgroups were
performed.
After adjustment for sex, age, race, education level, total household
income, body mass index, and smoking quantity/duration, menthol
cigarettes were linked to a 2.25-fold increase in stroke risk compared
with their nonmentholated counterparts. The increase was particularly
high in women and nonblack smokers.
After further adjustment for clinician-diagnosed, self-reported
hypertension, diabetes, and dyslipidemia, the risk remained
significantly increased among all, female, and nonblack smokers of
menthol cigarettes.
Table 1. Risk for Stroke With Menthol vs Nonmenthol Cigarettes
| Group | Odds Ratio (95% Confidence Interval) |
| Adjusted risk | |
| Menthol vs nonmenthol | 2.25 (1.33 - 3.78) |
| Women vs men | 3.28 (1.74 - 6.19) |
| Nonblack vs black | 3.48 (1.70 - 7.13) |
| With additional adjustment for hypertension, diabetes, and dyslipidemia | |
| Menthol vs nonmenthol | 2.19 (1.05 - 4.58) |
| Women vs nen | 3.54 (1.60 - 7.84) |
| Nonblack vs black | 3.02 (1.24 - 7.34) |
No significant increases were detected in the risks for other
diseases, such as hypertension, myocardial infarction, congestive heart
failure, or COPD, with menthol over regular cigarettes.
Table 2. Other Risks Associated With Menthol Cigarettes
| Cardiovascular Risk | Odds Ratio (95% Confidence Interval) |
| Hypertension | 1.17 (0.84 - 1.62) |
| Myocardial infarction | 0.89 (0.40 - 1.99) |
| Heart failure | 1.32 (0.56 - 3.15) |
| COPD | 1.06 (0.50 - 2.22) |
"These results highlight the need for further review of the last
legally allowed tobacco additive in North America, given that
mentholated cigarettes may be placing individuals at even greater risk
of potentially devastating cerebrovascular disease than regular
cigarettes," Dr. Vozoris concludes.
Dr. Vozoris has disclosed no relevant financial relationships.
Arch Intern Med. 2012;172:590-591. Abstract
Эх сурвалж:
