Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions

Core Tip

Core Tip: Recent North American and European studies indicate that current, compared to never cigarette smoking, increases risk in each sex by about 3-fold for acute myocardial infarction, about 2-fold for ischaemic heart disease (IHD), and about 1.6-fold for stroke. More limited evidence from Japanese studies suggests a similar increase in risk for IHD, but a lower increase, of about 1.2-fold, for stroke. The increase in risk is greater in heavier smokers. Limited recent data for cigar or pipe smoking, all from North America, finds no evidence of an increased risk of IHD or stroke, one study reporting a significantly reduced risk of stroke in exclusive pipe smokers. Our findings are generally consistent with evidence from earlier studies. Cigarette smoking increases risk of all the three diseases studied, but by a much smaller factor than noted for lung cancer and chronic obstructive pulmonary disease in our companion publication. Any increase in risk from cigar and pipe smoking has not been demonstrated.