title: Pipe and cigar smoking and major cardiovascular events, cancer incidence and all-cause mortality in middle-aged British men.
abstract: BACKGROUND
  Pipe and cigar smoking are still regarded by many as less hazardous to health than cigarette smoking.
  
  
  METHODS
  Prospective study of 7735 men aged 40-59 years drawn from general practices in 24 British towns with mean follow-up of 21.8 years. The outcome measures include major coronary heart disease (CHD) and stroke events, cancer incidence, and deaths from all causes.
  
  
  RESULTS
  There were 1133 major CHD events and 440 stroke events, 919 new cancers and 1994 deaths from all causes in the 7121 men with no diagnosed CHD, stroke, diabetes, or cancer at screening. Compared with never smokers, pipe/cigar smokers (primary and secondary combined) showed significantly higher risk of major CHD events (relative risk [RR] = 1.69, 95% CI: 1.32, 2.14) and stroke events (RR = 1.62, 95% CI: 1.08, 2.41) and of cardiovascular, non-cardiovascular, and total mortality (RR = 1.49, 95% CI: 1.13, 1.96, RR = 1.40, 95% CI: 1.08, 1.83 and RR = 1.44, 95% CI: 1.19, 1.74, respectively), after adjustment for lifestyle and biological characteristics. They also showed a significantly higher incidence of smoking-related cancers (RR = 2.67, 95% CI: 1.70, 4.26), largely due to lung cancer (RR = 4.35, 95% CI: 2.05, 8.94). Overall, the effects in pipe/cigar smokers were intermediate between never-smokers and light cigarette smokers, although risks for lung cancer were similar to light cigarette smokers.
  
  
  CONCLUSIONS
  Pipe and cigar smoking, whether primary or secondary, carries significant risk of smoking-related ill health.
authors.affiliation: Department of Primary Care and Population Sciences, Royal Free and University College Medical School, 8 Wentworth Hall, The Ridgeway, Mill Hill, London NW7 1RJ, UK. agshaper@wentworth.u-net.com
authors.forename: A G
authors.initials: AG
authors.lastname: Shaper
authors.forename: S G
authors.initials: SG
authors.lastname: Wannamethee
authors.forename: Mary
authors.initials: M
authors.lastname: Walker
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology