Menthol cigarettes contribute to higher death rates in smokers

In a large, nationwide study led by the American Cancer Society (ACS), researchers found mortality risks for smoking menthol cigarettes were higher than non-menthol cigarettes for death from any cause and cardiovascular diseases, especially heart diseases. Higher risks were evident in individuals who had quit smoking and at high smoking intensities. Black participants currently smoking menthol brands had high increases for some heart diseases with an 88% elevated mortality risk compared to non-menthol cigarettes. The report also showed quitting smoking substantially reduced health risks from both cigarette types. The findings are published today in the journal Tobacco Control.

Menthol in cigarettes is an established public health threat due to its effect on increasing smoking uptake and reducing smoking cessation. With these results additionally showing unique mortality effects, it's time for menthol cigarettes to be regulated to help save lives. In the U.S. and globally in many low- and middle-income countries, the share of menthol cigarettes in the market is substantial."

Dr. Priti Bandi, scientific director, risk factors and screening research at the American Cancer Society and lead author of the study

For the report, researchers followed nearly a million people from the Cancer Prevention Study II, a population-based prospective cohort enrolled in 1982-1983, and observed them for mortality outcomes over six years. All-cause and cause-specific mortality risk was assessed according to baseline smoking status (current, former, never) and menthol flavor status (menthol, non-menthol) of the cigarette brand smoked for the longest period.

Among 73,486 participants reporting menthol brands and 281,680 participants reporting non-menthol brands, there were 4,071 and 20,738 deaths, respectively. Participants currently smoking menthol or non-menthol cigarette brands had similarly high mortality risks compared to never smoking (e.g., death from any cause was about 2 times higher), but quitting substantially reduced the risk of death from both types of cigarettes. Among people who had quit smoking, a history of menthol versus non-menthol smoking was associated with an increased mortality risk of 12% from all causes, 16% from all cardiovascular diseases, 13% from ischemic or coronary artery disease, and 43% from other heart diseases. Among individuals currently smoking, there was no difference in mortality risks for menthol vs. non-menthol cigarettes, except for an elevated risk among those smoking 40 or more cigarettes per day and in Black individuals for some heart diseases.

"Continuing to smoke, whether menthol or non-menthol cigarettes, is the most harmful," added Bandi. "These findings reiterate that quitting all cigarette types is the only safe option to reduce your risk of disease and dying prematurely."

"Today's study proves once again why policymakers need to enact comprehensive policies that help individuals who currently use quit and prevent youth and young adults from becoming addicted to tobacco products," said Lisa A. Lacasse, president of ACS's advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN). "People who smoke deserve barrier-free access to comprehensive cessation services and support through quitlines, their health care providers, and state and federal programs. ACS CAN will continue to work to increase funding for tobacco prevention and cessation programs, end the sale of menthol cigarettes and all other flavored tobacco products, and enact other proven tobacco control policies, including comprehensive smoke-free laws and regular and significant tax increases on all tobacco products."

Other ACS researchers contributing to the study include Christina Newton, Zheng Xue, Dr. Samuel Asare, Dr. Minal Patel, Dr. Farhad Islami, Dr. Nigar Nargis, Dr. Alpa Patel, Dr. Ahmedin Jemal, Dr. J. Lee Westmaas, and senior author Ryan Diver.