Menthol and Nonmenthol Cigarette Smoking: All-Cause Deaths, Cardiovascular Disease Deaths, and Other Causes of Death Among Blacks and Whites

Circulation. 2016 May 10;133(19):1861-6. doi: 10.1161/CIRCULATIONAHA.115.020536. Epub 2016 Mar 28.


Background: In contrast to whites, black smokers prefer menthol cigarettes over nonmenthol cigarettes by a large margin and tend to have higher mortality from several smoking-related diseases than whites, raising the possibility that menthol cigarettes contribute to racial disparities in risk. Evidence for differential associations between menthol and nonmenthol cigarettes indicates lower cancer risk for menthol smokers, but for cardiovascular disease (CVD) mortality, evidence has been inconsistent.

Methods and results: Cox proportional hazards models were used to compute hazard ratios and accompanying 95% confidence intervals for all-cause and CVD mortality for menthol compared with nonmenthol cigarette smokers among 65 600 participants in the Southern Community Cohort Study, an ongoing community-based cohort with the largest number of menthol smokers being traced. Among the 27 619 current cigarette smokers, 4224 died during follow-up, with 1130 deaths attributed to CVD. Both all-cause (hazard ratio=0.93; 95% confidence interval=0.86-1.01; P=0.10) and CVD (hazard ratio=0.88; 95% confidence interval=0.76-1.03; P=0.10) mortality risks were similar in menthol compared with nonmenthol cigarette smokers.

Conclusions: Smoking regardless of cigarette type is hazardous to health, but these results do not indicate that menthol cigarettes are associated with greater CVD risks than nonmenthol cigarettes.

Keywords: cardiovascular diseases; epidemiology; mortality; smoking.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Black People* / ethnology
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Healthcare Disparities / ethnology
  • Humans
  • Male
  • Menthol / administration & dosage*
  • Menthol / adverse effects
  • Middle Aged
  • Prospective Studies
  • Smoking / adverse effects
  • Smoking / ethnology
  • Smoking / mortality*
  • Southeastern United States / epidemiology
  • Tobacco Products / adverse effects*
  • White People* / ethnology


  • Menthol