Menthol cigarette smoking has higher risk of death

Researchers report that the risk of death risk from smoking menthol cigarettes is higher than from smoking non-menthol cigarettes, for death from any cause and for death from cardiovascular diseases, especially heart diseases.

The findings were published on Feb. 13, 2025 in the journal Tobacco Control.

“Menthol in cigarettes is an established public health threat due to its effect on increasing smoking uptake and reducing smoking cessation,” said Priti Bandi, PhD,  scientific director of risk factors and screening research at the American Cancer Society and lead author of the study. “With these results additionally showing unique mortality effects, it’s time for menthol cigarettes to be regulated to help save lives.”

The authors noted that menthol-flavored cigarettes are unregulated in the USA and in many low- and middle- income countries in spite their established adverse impacts on smoking uptake and on smoking cessation.

It has been inconclusive to date whether menthol cigarettes are associated with higher disease risks than non-menthol cigarettes.

The investigators extracted data on 969,349 smoking and non-smoking subjects from the Cancer Prevention Study II,  a prospective study enrolled in 1982–1983 with mortality follow-up of 6 years.

They assessed the data on all-cause and cause-specific mortality risk according to baseline smoking status (current, former, never) and menthol flavor status (menthol, non-menthol) of the brand smoked for the longest period.

They found that for 73,486 subjects who reported smoking menthol brands and 281,680 subjects who reported smoking non-menthol brands, there were 4,071 and 20,738 deaths, respectively.

Compared to subjects who had never smoked, those currently smoking either menthol or non-menthol cigarette brands had similarly high mortality risks (about double) compared to never smokers.

However, they also found that quitting smoking substantially reduced the risk of death from both menthol and non-menthol cigarettes.

The main finding of the study was that among subjects who stopped smoking during the 6 years of follow-up,  a history of menthol versus non-menthol cigarette smoking was associated with an increased mortality risk of 12% from all causes, 16% from all cardiovascular diseases, 13% from ischemic or coronary artery disease and 43% from other heart diseases.

For subjects who continued to smoke there was no overall difference in mortality risks for menthol vs. non-menthol cigarettes.

A notable exception was among Black subjects who smoked menthol brands and had an 88% elevated mortality risk compared to non-menthol smokers.

“Continuing to smoke, whether menthol or non-menthol cigarettes, is the most harmful,” added Bandi. “These findings reiterate that quitting all cigarette types is the only safe option to reduce your risk of disease and dying prematurely.”