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Menthol Cigarettes, Smoking Cessation, Atherosclerosis, and Pulmonary Function
The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Mark J. Pletcher, MD, MPH;
Benjamin J. Hulley;
Thomas Houston, MD;
Catarina I. Kiefe, MD, PhD;
Neal Benowitz, MD;
Stephen Sidney, MD, MPH
Arch Intern Med. 2006;166:1915-1922.
Background African American smokers are more likely to experience tobacco-related morbidity and mortality than European American smokers, and higher rates of menthol cigarette smoking may contribute to these disparities.
Methods We prospectively measured cumulative exposure to menthol and nonmenthol cigarettes and smoking cessation behavior (1985-2000), coronary calcification (2000), and 10-year change in pulmonary function (1985-1995) in African American and European American smokers recruited in 1985 for the Coronary Artery Risk Development in Young Adults Study.
Results We identified 1535 smokers in 1985 (972 menthol and 563 nonmenthol); 89% of African Americans preferred menthol vs 29% of European Americans (P<.001). After adjustment for ethnicity, demographics, and social factors, we found nonsignificant trends in menthol smokers toward lower cessation (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.49-1.02; P = .06) and recent quit attempt (OR, 0.77; 95% CI, 0.56-1.06; P = .11) rates and a significant increase in the risk of relapse (OR, 1.89; 95% CI, 1.17-3.05; P = .009). Per pack-year of exposure, however, we found no differences from menthol in tobacco-related coronary calcification (adjusted OR, 1.27; 95% CI, 1.01-1.60 for menthol cigarettes and 1.33; 95% CI, 1.06-1.68 for nonmenthol cigarettes per 10–pack-year increase; P = .75 for comparison) or 10-year pulmonary function decline (adjusted excess decline in forced expiratory volume in 1 second, 84 mL; 95% CI, 32-137 for menthol cigarettes and 80 mL; 95% CI, 30-129 for nonmenthol cigarettes, per 10–pack-year increase; P = .88 for comparison).
Conclusion Menthol and nonmenthol cigarettes seem to be equally harmful per cigarette smoked in terms of atherosclerosis and pulmonary function decline, but menthol cigarettes may be harder to quit smoking.
Author Affiliations: Departments of Epidemiology and Biostatistics (Dr Pletcher), Medicine (Drs Pletcher and Benowitz), and Psychiatry (Dr Benowitz), University of California, San Francisco; University of California, San Diego, School of Medicine (Mr Hulley); Division of Preventive Medicine, University of Alabama at Birmingham (Drs Houston and Kiefe); Deep South Center on Effectiveness, Veterans Affairs Medical Center, Birmingham (Dr Kiefe); Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center (Dr Benowitz); and Division of Research, Kaiser Permanente, Oakland, Calif (Dr Sidney).
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