Cigar smoking is increasing in the United States, mainly in young and middle-aged men, but also among teenagers and women. In some circles it has even achieved a certain social status. It may be people think that cigar smoking is a safer alternative to cigarettes. This is not the case - the practice is known to be a risk factor for cancer of the mouth, throat, larynx, gullet (esophagus) and lung, and also and for a troublesome breathing condition - chronic obstructive pulmonary disease (COPD). So far it was not known whether it carried an increased risk of cardiovascular disease, but a recent study has provided evidence to that effect.¹

Over 17,500 men aged 30 to 85 were enrolled in the Kaiser Permanente Medical Care Program between 1964 and 1973. They had never smoked cigarettes, and were not currently pipe smokers. Their health was carefully followed from 1971 through 1996, using hospitalization discharge records and local tumor registries.

There were over 1,500 cigar smokers at entry - about 9% of the total - and their subsequent health records were compared with those of the 91% non-smokers. The analyses took into account the health information collected at enrollment, medical history, alcohol consumption, and any exposure to occupational hazards such as solvents, pesticides, asbestos and silica.

The cigar smokers were slightly older, more obese, had higher blood pressure, higher cholesterol levels and were more likely to have diabetes, than non-cigar smokers; also, they consumed more alcohol than non-smokers. Most of them smoked less than 5 cigars a day.

After adjusting for age, it was found that cigar smokers were 1.27 times more likely to develop coronary heart disease, and 1.45 times more likely to develop COPD, than non-smokers. There was no evidence that cigar smokers were more likely to have a stroke or disease of the leg arteries than non-smokers.

Cigar smokers had about twice the risk of cancer of the throat, larynx, esophagus and lung as non-smokers. The risks were greater among those who smoked 5 or more cigars daily, compared with those who smoked fewer than 5. Alcohol consumption seemed to increase the risk for these cancers (except cancer of the lung) still further. Cigar smoking was not associated with an increased risk of cancer of the pancreas, kidney, bladder, colon or rectum.

Obviously, these findings must be compared with those for cigarette smoking. Various studies have shown that cigarette smoking by men causes a 1.5 to 3 times likelihood of coronary heart disease, 9 to 25 times the risk of COPD, 8 to 24 times the risk for lung cancer and 4 to 12 times the risk for mouth/throat cancer. However, as about half the cigar smokers in the Kaiser Permanente study said that they quit smoking within the first 8 years after enrollment, the actual effects of cigar smoking may have been underestimated. Cigar smoke is not usually deeply inhaled, which may explain the lowered risks of COPD and lung cancer among cigar smokers, compared with cigarette smokers.

The resurgence of cigar smoking in the United States in recent years is worrying, in view of the findings of this, and other, studies. Older persons, even if non-smokers themselves, can play an effective role by advising their children (and grandchildren) about the risks of all forms of tobacco.