The New England Journal of Medicine -- June 10, 1999 -- Vol. 340, No.23
Carlos Iribarren, Irene S. Tekawa, Stephen Sidney, Gary D. Friedman
Background. The sale of cigars in the United States has been increasing
since 1993. Cigar smoking is a known risk factor for certain cancers and
for chronic obstructive pulmonary disease (COPD). However, unlike the relation
between 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
Permanente health plan and who reported that they had never smoked cigarettes
and did not currently smoke a pipe. Those who smoked cigars (1546 men) and
those who did not (16,228) were followed from 1971 through the end of 1995
for 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 nonsmokers,
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
percent confidence interval, 1.10 to 1.91), and cancers of the upper aerodigestive
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 to 4.11),
with evidence of dose-response effects. There appeared to be a synergistic
relation between cigar smoking and alcohol consumption with respect to the
risk of oropharyngeal cancers and cancers of the upper aerodigestive 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.)
From the Division of Research, Kaiser Permanente Medical Care Program,
Oakland, Calif. Address reprint requests to Dr. Iribarren at the Division
of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland,
CA 94611 or email by clicking here.
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