Cardiovascular and other diseases in smokers of low yield cigarettes

doi:10.1016/0021-9681(85)90047-5

Journal of Chronic Diseases

Volume 38, Issue 7, 1985, Pages 581-588

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(85)90047-5 Get rights and content

Abstract

The association of smoking low yield cigarettes with the risk of cancer, cardiovascular disease, and other disease associated previously with smoking is controversial. In 1979 we began a prospective epidemiologic study of this subject. We here report on the first 4 years of follow-up in the 16,270 current, regular cigarette smokers and the 42,113 subjects who never used any form of tobacco enrolled in the study. In multivariate analyses that included age, sex, race, number of cigarettes smoked per day and other factors related to cardiovascular disease, the risk of cardiovascular diseases was consistently higher in smokers of higher than in smokers of lower yield cigarettes, although the magnitude of the difference in risk was very small. The risks of cancer of the trachea, bronchus and lung, of all smoking-related cancers as a group, of diseases of the respiratory system, and of peptic ulcer diseases were not significantly associated with yield in smokers. The incidence rates of cardiovascular diseases considered as a group, cancer of the trachea, bronchus, and lung and all smoking-related cancers were higher in smokers of low yield cigarettes than in never users of any form of tobacco. We conclude that the smoking of low yield cigarettes is not without associated hazard. On the other hand, the results suggest that smokers who cannot quit might best use the least number of the lowest yield cigarette.

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Morbidity and mortality in relation to smoking among women and men of Chinese ethnicity: The Singapore Chinese Health Study
2008, European Journal of Cancer
Citation Excerpt :
Our findings on stroke mortality are contrary to the US Surgeon General’s report1 which concluded that smoking is positively related to stroke risk, particularly ischemic stroke and subarachnoid haemorrhage. The US report was predominantly based on studies from Western populations2,18–26; only two studies from Asian populations were included.31,78 One explanation for the observed lack of association may be the reported heterogeneous nature of the association between smoking and stroke subtypes, including a potential lack of association with intracerebral haemorrhage79 and embolic brain infarction.80
We examined the association among cigarette smoking, smoking cessation and a broad range of cancer incidence and all cause and cause-specific mortality in a population-based cohort of adults of Chinese ethnicity in Singapore.
Subjects were 61,320 participants of the Singapore Chinese Health Study (44.5% men, aged 45–74 years, recruitment from 1993–1998) who were free of cancer at the baseline examination. Main outcomes-of-interest included cancer incidence, all cause and cause-specific mortality as of December 31, 2005.
Cigarette smoking was positively associated with overall cancer incidence, including cancers at the following specific sites: head and neck region, upper gastrointestinal tract, hepatobiliary and pancreas cancer, lung, and bladder/renal pelvis cancer. Compared to never smokers, the relative risk (RR) (95% confidence interval [CI]) of cancer incidence (all cancer sites) among current smokers smoking >22 cigarettes/day was 1.9 (1.7–2.1), p-trend < 0.0001. Similarly, cigarette smoking was associated with all cause and cause-specific mortality, including deaths due to cancer, ischemic heart disease, other heart diseases, and chronic obstructive pulmonary disease. Compared to never smokers, RR (95%CI) of all cause mortality among current smokers smoking >22 cigarettes/day was 1.8 (1.6–2.0), p-trend < 0.0001. Also, relative to current smokers, ex-smokers experienced reduced cancer incidence and total mortality. The population attributable risk of smoking in men for cancer incidence as well as all-cause mortality was 23%, whereas in women it ranged from 4–5%.
Cigarette smoking is an important risk factor for cancer incidence and major causes of mortality in Chinese men and women of Singapore.
Epidemiology of smoking-induced cardiovascular disease
2003, Progress in Cardiovascular Diseases
Cigarette smoking is a major cause of coronary heart disease, stroke, aortic aneurysm, and peripheral vascular disease. The risk is manifest both as an increased risk for thrombosis of narrowed vessels and as an increased degree of atherosclerosis in those vessels. The cardiovascular risks owing to cigarette smoking increase with the amount smoked and with the duration of smoking. Risks are not reduced by smoking cigarettes with lower machine-measured yields of tar and nicotine, but those who have only smoked pipes or cigars seem to have a lower risk for cardiovascular diseases. Cessation of cigarette smoking reduces disease risks, although risks may remain elevated for a decade or more after cessation.
Is compulsory restriction of tar yield of cigarettes a worthwhile public health policy?
2001, American Journal of Preventive Medicine
Background: Although the notion of a “safe cigarette” has proved an illusion, while people continue to smoke, an issue remains of whether compulsory restriction of tar yield is a worthwhile public health policy.
Methods: The study group was comprised of a random population sample of middle-aged Scottish men and women—3464 smokers of cigarettes with known tar yield at baseline. Tar yields were classified into low (<10 mg), low/middle (10–14.99 mg), and middle or high (≥15 mg), according to standard groupings. Deaths within the study cohort were recorded over a period of 13 years.
Results: Among low, low/middle, and middle or high tar smokers, 55 (10%), 178 (16%), and 276 (16%), respectively, died. In a comparison group of lifetime never-smokers, 178 (6%) died. After adjustment for daily cigarette dose, duration of smoking, age, gender, social class, type A personality, body mass index, urinary potassium, and antioxidant vitamin consumption, hazard ratios (95% confidence intervals) for all-cause mortality comparing low-tar smokers to low/middle-tar smokers and to middle- or high-tar smokers were 1.64 (1.04–2.58) and 1.46 (0.95–2.26), respectively. Corresponding results for cardiovascular disease were 1.48 (0.74–2.96) and 1.35 (0.79–2.60). For lung cancer, after adjusting for known confounding factors, corresponding hazard ratios were 2.82 (0.98–8.15) and 2.30 (0.81–6.49).
Conclusions: Smoking any type of cigarette is far more risky than abstaining altogether. Although the results obtained comparing tar levels are limited because of lack of repeat measures of smoking during follow-up, potential residual confounding factors, statistical imprecision, and failure to show a dose-response relationship, results do support the hypothesis that persistent smokers will reduce their tobacco-induced health risk if they smoke cigarettes with <10 mg of tar. However, the data do not permit quantification of the benefits of switching to lower-tar cigarettes. Worldwide legislation to limit tar levels to 10 mg as an absolute maximum is recommended, while recognizing that this must be part of an integrated approach to tobacco control.
Risk factors associated with the development of peripheral arterial disease in smokers: A case-control study
1997, Atherosclerosis
Purpose and method: A hospital based case-control study was designed to investigate what aspects of smoking and what co-factors of smoking are associated with the development of peripheral arterial disease (PAD). Cases were 291 smokers, newly referred with PAD, and controls were 828 age and sex matched smokers without PAD. Results: Reported recent tobacco usage was similar in cases and controls but total tobacco exposure was associated with the risk of PAD—adjusted odds ratios (ORs) increasing with tertile of pack-years smoked to reach 1.63 (95% CI, 1.11–2.39; P=0.011), for the highest tertile (>48 pack-years) compared with smokers in the lowest tertile (<31 pack-years). Cases reported smoking significantly lower tar and nicotine yield cigarettes than controls, but tended to inhale more deeply, and had significantly higher plasma concentrations of cotinine. ORs for PAD were significantly and independently increased by systolic blood pressure ≥160 mmHg (8.1 (5.2–13.0); P<0.0001), history of hypertension (2.4 (1.5–3.2); P=0.0003) and apolipoprotein B>0.9 g/l(3.8 (2.3–7.6); P=0.008). Conclusions: Increased total exposure to tobacco and the ability to smoke tobacco in a way which maximises nicotine yield are associated with increased risk of smokers developing PAD. There is no evidence that smoking low tar cigarettes reduces this risk, whereas both hypertension (particularly systolic) and high levels of apolipoprotein B, increase this risk.
Alcohol drinking and cigarette smoking: an exploration of the association in middle-aged men and women
1991, Drug and Alcohol Dependence
The association of alcohol and cigarette consumption was explored among 13 673 black or white persons aged 40–49 years, who received check-ups from mid-1979 to 1985. Alcohol use was strongly associated with number of cigarettes smoked per day, but not with tar-yield, mentholation and presence of filters. Duration of cigarette use, frequency and depth of inhalation, proportion of cigarette smoked and greater time from arising to first cigarette were significantly related to alcohol use in some but not all race-sex groups. Among smokers who consumed alcohol, liquor drinkers smoked the most cigarettes per day and wine drinkers the least. Thus, the association between alcohol drinking and cigarette smoking is strong in middle-aged persons but there are race- and sex-related disparities when specific aspects of smoking behaviour are considered.
Tar level of cigarettes smoked and risk of smoking-related diseases
2018, Inhalation Toxicology

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Original articleCardiovascular and other diseases in smokers of low yield cigarettes

Abstract

Envir Res

Lancet

Lancet

Report on A Second Retrospective Mortality Study in North-East England. Part I: Factors Related to Mortality from Lung Cancer, Bronchitis, Heart Disease and Stroke in Cleveland County, with Particular Emphasis on the Relative Risks Associated with Smoking Filter and Plain Cigarettes

Cigarettes, lung cancer, and coronary heart disease: the effects of inhalation and tar yield

J Epid Commun Health

Impact of long-term filter cigarette usage on lung and larynx cancer risk: a case-control study

J Natl Cancer Inst

Nicotine and carbon monoxide content of cigarette smoke and the risk of myocardial infarction in young men

N Engl J Med

Smoking and health: the association between smoking behavior, total mortality, and cardiorespiratory disease in west central Scotland

J Epid Commun Health

Original article
Cardiovascular and other diseases in smokers of low yield cigarettes