Cigars Double Risk Of Cardiomyopathy

March 19, 1998

SANTA FE, N.M., March 19 -- With U.S. cigar sales up 44 percent since 1993, a major new health study on the effects of cigar smoking offers both good news and bad news for the growing number of American men and women now puffing "stogies," say researchers today at the American Heart Association's epidemiology and prevention conference.

The good news, according to Carlos Iribarren, M.D., Ph.D., who reported the study, is that cigar smoking alone, unlike cigarette smoking, does not seem to increase the risk of dying from coronary heart disease. Coronary heart disease, which results from the narrowing of the blood vessels that feed the heart, causes heart attacks.

But the bad news is that regular cigar smokers face almost double the risk of dying of all forms of cancer combined and of certain circulatory conditions, which include hypertensive heart disease (damage to the heart as a result of high blood pressure), cardiomyopathy (deterioration of the heart muscle), and other types of potentially deadly cardiovascular ailments, says Iribarren, an epidemiologist with the division of research at the Kaiser Pemanente Medical Care Program, Oakland, Calif.

The mechanisms by which cigar smoking may induce or promote these circulatory conditions are still unknown, Iribarren notes. "However, it is well documented that cigar smoke is a source of toxins such as carbon monoxide, benzene, benzo(a)pyrene, and nicotine, and that nicotine can be readily absorbed through the buccal mucosa (the cheeks)."

Despite the severe health hazards associated with cigarettes, tobacco marketers have increasingly popularized cigars, particularly the large, expensive variety. The result has been a sharp increase in cigar consumption, which is expected to continue in the near future.

"Because cigar smoke isn't usually inhaled to the same degree as cigarette smoke, and because the health consequences of cigar smoking aren't well documented, many people believe that cigars don't pose any significant health risks," Iribarren says. "Our study shows that this may not be the case, however."

In the long-term study, the death rates of 225 men, ages 30-89 years, who smoked only cigars, was monitored over an average period of up to 16 years. The control groups included over 14,200 men who reported never smoking any form of tobacco.

Cigar smokers had a 25 percent higher death rate and twice the risk of dying from all forms of cancer combined, as well as from miscellaneous cardiovascular causes other than coronary heart disease. These miscellaneous conditions included hypertensive heart disease, cardiomyopathy and aortic aneurysm.

The study adjusted for other factors known to influence the risk of heart disease and cancer, including older age, race, education, alcohol consumption, blood pressure, body weight and level of blood cholesterol. Participants in the study were drawn from more than 110,000 Kaiser Permanente members who filled out questionnaires on smoking between 1979 and 1985. Follow-up continued through the end of 1995.

The unique quality about this study was its ability to make a clear, specific comparison between "pure" cigar smokers and those denying use of any tobacco product, say the study authors. With this study design, the influence of concomitant or past cigarette or pipe smoking is ruled out.

"We also looked at such variables among cigar smokers as inhalation practice, number of cigars smoked, and years as cigar smokers, but were unable, because of the small number of events in subgroups of cigar smokers, to draw firm conclusions as to how these factors might contribute to health risk and death.

"At Kaiser Permanente Division of Research, we are currently conducting a larger scale investigation to elucidate how these other variables influence the risk of hospitalization for non-fatal heart and circulatory diseases, as well as incidence of site-specific cancers such as cancers of the lung and oropharyngeal (throat)," says Iribarren.

This study was presented at the American Heart Association's 38th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. Co-authors are Stephen Sidney, M.D., M.P.H.; Irene Tekawa, M.S.; and Gary Friedman, M.D., all from Kaiser Permanente (N. California Region) Division of Research.

American Heart Association

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