Cigarette smoking risks are well known, but cigars are also combustible tobacco products.  Do cigars present the same health risks as cigarettes?


Researchers from the Kaiser Medical Care Program, one of the nation’s largest health care maintenance organizations, provided the answer in 1999 by publishing an excellent study on cigar smoking in the New England Journal of Medicine (abstract here).  They followed 16,228 never smokers and 1,546 cigar smokers – all men – for 25 years, and compared rates of several diseases among them.  Cigar smokers were divided into those smoking less than 5 cigars a day (let’s call them moderate), and 5 or more (heavy).


Compared with never smokers, heavy cigar smokers were shown to have increased risks for several smoking related diseases.  They had higher risks for heart disease (Relative Risk, RR = 1.6, 95% confidence interval, CI = 1.2 – 2.0), emphysema (RR = 2.3, CI = 1.4 – 3.7), oral and pharynx cancer (RR = 7.2, CI = 2.4 – 21.2), and lung cancer (RR = 3.2, CI = 1.01 – 10.4).


The good news: Moderate cigar smokers had only a slightly higher risk for heart disease (RR = 1.2, CI = 1.03 – 1.4).  Those smoking fewer than 5 cigars daily had no significantly increased risks for stroke, emphysema, oral/pharynx cancer or lung cancer.


The comparable health risks of smokeless tobacco (ST), cigars and cigarettes are shown below.


Health Risks Among Users of Tobacco Products
Disease Smokeless Tobacco Users Moderate Cigar Smokers Heavy Cigar Smokers Cigarette Smokers
Heart Disease Very Small Very Small Small Small
Stroke None None None Very Small
Emphysema None None Small High
Oral and Pharynx Cancer None None Moderate High
Lung Cancer None None Small High


Smokeless Tobacco Users – numerous epidemiologic studies discussed in this blog.
Cigars smokers – the Kaiser study discussed here.
Cigarette smokers – the Centers for Disease Control.


Risk Definitions:
None, No significant risk
Very small, Relative Risk (RR) < 2
Small, RR = 2 – 4
Moderate, RR = 4 – 8
High, RR > 8


Cigars, the data show, have few health effects when used in moderation.  One of the reasons that cigar (and pipe) smokers have lower risks than cigarette smokers is that they puff without inhaling.  In addition, they smoke less: 76 percent of cigar smokers in this study were in the moderate use group.  Those who smoke even fewer cigars probably have lower risks.


Still, even moderate cigar smokers had a 20% increase in heart disease risk, which is consequential.  That increased risk is, however, of the same magnitude that most Americans experience when they eat meat (as compared to heart disease risk for vegetarians).  Lifestyle choices have consequences; consumers should use research results to inform their choices, including those concerning tobacco.


Cigarette smoking causes “preventable illness and premature death,” as U.S. Surgeon General David Satcher noted in 1999, but other tobacco products, including smokeless tobacco, cigars and pipes, have far fewer health risks.  Consumers should know the facts, weigh the implications, and make reasoned choices.

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