Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men

Background The sale of cigars in the United States has been increasing sinc e 1993. Cigar smoking is a known risk factor for certain cancers and for ch ronic obstructive pulmonary disease (COPD). However, unlike the relation be tween cigarette smoking and cardiovascular disease, the association between cigar smoking and cardiovascular disease has not been clearly established. Methods We performed a cohort study among 17,774 men 30 to 85 years of age at base line (from 1964 through 1973) who were enrolled in the Kaiser Perma nente health plan and who reported that they had never smoked cigarettes an d did not currently smoke a pipe. Those who smoked cigars (1546 men) and th ose who did not (16,228) were followed from 1971 through the end of 1995 fo r a first hospitalization for or death from a major cardiovascular disease or COPD, and through the end of 1996 for a diagnosis of cancer. Results In multivariate analyses, cigar smokers, as compared with nonsmoker s, were at higher risk for coronary heart disease (relative risk, 1.27; 95 percent confidence interval, 1.12 to 1.45), COPD (relative risk, 1.45; 95 p ercent confidence interval, 1.10 to 1.91), and cancers of the upper aerodig estive tract (relative risk, 2.02; 95 percent confidence interval, 1.01 to 4.06) and lung (relative risk, 2.14; 95 percent confidence interval, 1.12 t o 4.11), with evidence of dose-response effects. There appeared to be a syn ergistic relation between cigar smoking and alcohol consumption with respec t to the risk of oropharyngeal cancers and cancers of the upper aerodigesti ve tract. Conclusions Independently of other risk factors, regular cigar smoking can increase the risk of coronary heart disease, COPD, and cancers of the upper aerodigestive tract and lung. (N Engl J Med 1999;340: 1773-80.) (C) 1999, Massachusetts Medical Society.