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Am Fam Physician. 1999;60(9):2672-2674

Cigar smoking has become increasingly popular in the United States, reflected by a nearly 50 percent increase in cigar sales from 1993 to 1997. Most smokers are young and middle-aged men, although there has also been an increase among women and teenagers. Two reasons for the increase are the perception that cigars are less harmful than cigarettes and the intense marketing and glamorization of cigars by manufacturers. Unlike the case with cigarettes, there is little information in the medical literature concerning the adverse health effects of cigar smoking. Iribarren and colleagues examined the risk of coronary artery disease, chronic lung disease, stroke and cancer in a cohort of men who smoked cigars regularly.

Study participants were men between 30 and 85 years of age who belonged to a large managed care organization. These men had no history of smoking cigarettes and were not currently pipe smokers. A self-administered questionnaire was used to gather information on drinking and smoking habits. The degree of smoking was quantified to fewer than five, five to 10, or more than 10 cigars per day. Baseline data obtained included the degree of alcohol consumption, serum cholesterol levels and medical history. This latter piece of information included diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease.

Data on the incidence of various cancers were obtained from medical records and tumor registries. Patients were followed and the incidence of malignancies, COPD and fatal and nonfatal cardiovascular events was tracked from 1971 until 1996.

From the cohort of 17,774 men, 1,546 reported themselves to be cigar smokers. Of these, 1,177 smoked less than five per day, 263 smoked more than five, and 106 men said they smoked an unknown amount.

The average age was 47 years, and approximately 79 percent of participants were white. The smokers were more likely than nonsmokers to consume alcohol regularly. Age-adjusted rates for COPD and all cardiovascular outcomes were significantly higher for the cigar smokers. There was no difference in the number of strokes and the rate of peripheral vascular disease between smokers and nonsmokers. Cigar smokers had a significantly higher incidence of oropharyngeal cancers and lung cancer. Other cancers studied—bladder, colorectal, kidney and pancreatic—were slightly more common in smokers but not significantly so. The incidence of oropharyngeal cancer increased with the number of drinks consumed per day. The relative risk increased to 7.56 in men who had four or more drinks per day.

The authors concluded that cigar smoking, especially more than five per day, produces a moderate increase in the risk of coronary artery disease, COPD and cancers of the lung and upper aerodigestive tract. This is a concern in light of the growing popularity of cigar smoking in recent years.

editor's note: In an accompanying editorial, U.S. Surgeon General David Satcher reemphasizes the fact that cigar sales have increased by 50 percent from 1993 to 1998, while cigarette consumption declined by 3 percent nationwide. He strongly advocates the placement of warning labels on cigars as is now mandated for all cigarette and smokeless tobacco products.—j.t.k.

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Copyright © 1999 by the American Academy of Family Physicians.

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