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Cigarette Yield and the Risk of Myocardial Infarction in Smokers
William H. Sauer, MD;
Jesse A. Berlin, ScD;
Brian L. Strom, MD, MPH;
Carolyn Miles, MPH;
Jeffrey L. Carson, MD;
Stephen E. Kimmel, MD, MSCE
Arch Intern Med. 2002;162:300-306.
Background Although cigarette smoking is a major risk factor for acute myocardial
infarction (MI), cigarette tar yield has not been clearly demonstrated to
affect MI risk.
Methods A case-control study of first MI in smokers aged 30 through 65 years
was conducted among 68 hospitals in an 8-county area during a 28-month period.
Case subjects were smokers hospitalized at any of the area hospitals with
a first MI. Approximately 4 community control smokers per case subject were
randomly selected from the same geographic area using random digit dialing.
Detailed data on smoking history and cigarette brand were collected.
Results We identified 587 case subjects and 2685 controls who smoked cigarettes
with known tar yields. After adjustment using multivariable logistic regression,
the odds ratios (ORs) for subjects smoking medium- and high compared with
low-tar-yield cigarettes were 1.86 (95% confidence interval [CI], 1.21-2.87)
and 2.21 (95% CI, 1.47-3.34), respectively. The adjusted OR increased as tar
per day intake increased (P<.001 for the trend);
compared with the lowest category of tar per day, the ORs (95% CIs) for increasing
tar per day were 1.16 (0.83-1.62), 1.85 (1.35-2.52), 2.42 (1.54-3.78), and
2.50 (1.78-3.52). There was a similar trend of increasing ORs as tar per day
increased in smokers of lower-yield cigarettes (P<.001
for the trend) and when low-yield cigarette smokers were excluded (P<.001 for the trend).
Conclusions Smoking higher-yield cigarettes is associated with an increased risk
of MI, and there is a dose-response relationship between total tar consumption
per day and MI.
From the Department of Medicine, Cardiovascular Division (Drs Sauer
and Kimmel), Division of General Internal Medicine (Dr Strom), and the Center
for Clinical Epidemiology and Biostatistics and Department of Biostatistics
and Epidemiology (Drs Berlin, Strom, and Kimmel and Ms Miles), University
of Pennsylvania School of Medicine, Philadelphia; Department of Medicine,
Division of General Internal Medicine, University of Medicine and Dentistry
of New Jersey, New Brunswick (Dr Carson).
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