title: Cigarette yield and the risk of myocardial infarction in smokers.
abstract: BACKGROUND
  Although cigarette smoking is a major risk factor for acute myocardial infarction (MI), cigarette tar yield has not been clearly demonstrated to affect MI risk.
  
  
  METHODS
  A case-control study of first MI in smokers aged 30 through 65 years was conducted among 68 hospitals in an 8-county area during a 28-month period. Case subjects were smokers hospitalized at any of the area hospitals with a first MI. Approximately 4 community control smokers per case subject were randomly selected from the same geographic area using random digit dialing. Detailed data on smoking history and cigarette brand were collected.
  
  
  RESULTS
  We identified 587 case subjects and 2685 controls who smoked cigarettes with known tar yields. After adjustment using multivariable logistic regression, the odds ratios (ORs) for subjects smoking medium- and high compared with low-tar-yield cigarettes were 1.86 (95% confidence interval [CI], 1.21-2.87) and 2.21 (95% CI, 1.47-3.34), respectively. The adjusted OR increased as tar per day intake increased (P<.001 for the trend); compared with the lowest category of tar per day, the ORs (95% CIs) for increasing tar per day were 1.16 (0.83-1.62), 1.85 (1.35-2.52), 2.42 (1.54-3.78), and 2.50 (1.78-3.52). There was a similar trend of increasing ORs as tar per day increased in smokers of lower-yield cigarettes (P<.001 for the trend) and when low-yield cigarette smokers were excluded (P<.001 for the trend).
  
  
  CONCLUSIONS
  Smoking higher-yield cigarettes is associated with an increased risk of MI, and there is a dose-response relationship between total tar consumption per day and MI.
authors.affiliation: Department of Medicine, Cardiovascular Division, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Berlin
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
authors.forename: Carolyn
authors.initials: C
authors.lastname: Miles
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kimmel
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D015996:Survival Rate; D014026:Nicotiana / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology