An Evaluation of the Effect of Smoking on Coronary Heart Disease

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Abstract
In January 1964, the Surgeon General's Advisory Committee on Smoking and Health1in considering the available information on smoking and coronary heart disease (CHD) (International Statistical Classification [ISC] 420) reported that "male cigarette smokers have a higher death rate from coronary artery disease than nonsmoking males, but it is not clear that the association has casual significance." Three points should be noted. First, the committee left no doubt that there was a consistent statistically significant association among cigarette smokers of increased mortality and morbidity from CHD in men, particularly during middle life. Seven large completed or current prospective studies of smoking and death rate gave a CHD median mortality ratio (current cigarette smokers to nonsmokers) of 1.7, with no significant excess deaths among cigar and pipe smokers. Second, the committee recognized that certain factors other than smoking were known or thought to predispose to the condition or to be

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