Cigar smoking and death from coronary heart disease in a prospective study of US men.

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Abstract
THE NUMBER of cigars consumed in the United States increased by nearly 50% between 1993 and 1996.1 This rapid increase is particularly striking because it followed a 66% decline from 1964 to 1992.2 While cigarette smoking is a well established and important cause of death from coronary heart disease (CHD),3 the potential cardiovascular effects of cigar smoking are unclear. In 1983, a Surgeon General's report concluded that cigar smoking did not appear to substantially increase risk of CHD.3 However, this conclusion was based on studies from the 1950s and 1960s that focused on cigarette smoking and often did not address important issues such as the distinction between current and former cigar smoking or confounding by risk factors such as preexisting heart disease, obesity, and exercise.4-6 We examined CHD mortality in a large and more recent study of US men to assess the association between CHD mortality and cigar smoking.