Cigar smoking and death from coronary heart disease in a prospective study of US men

Context: The prevalence of cigar smoking has increased rapidly in the United States since 1993. Although cigarette smoking is known to be an important cause of coronary heart disease (CHD) mortality, the relationship between cigar smoking and CHD mortality is unclear. Objective: To determine whether cigar smoking increases risk of CHD mortality. Design: Prospective cohort study with follow-up for mortality from 1982 through 1991. Setting: United States. Participants: A total of 121 278 men, aged 30 years and older, in the American Cancer Society's nationwide Cancer Prevention Study II cohort who completed a baseline questionnaire on smoking history and other risk factors in 1982, had never smoked cigarettes or pipes, and had no diagnosed heart disease or diabetes at baseline. Main Outcome Measure: Death from CHD recorded as the underlying cause of death on the death certificate. Results: There were 2508 deaths from CHD from 1982 through 1991. The association between cigar smoking and death from CHD was stronger among younger men and current rather than former smokers, as is observed with cigarette smoking. No increased risk was observed among current cigar smokers aged 75 years or older, or for former cigar smokers of any age. For men younger than 75 years who were current cigar smokers at baseline, the adjusted rate ratio for CHD mortality was 1.30 (95% confidence interval, 1.05-1.62). Conclusions: These results suggest that smoking cigars increases risk of early death from CHD. Any adverse effect of cigars on CHD is of particular importance given the rapidly rising prevalence of cigar smoking in the United States.