A sweeping nationwide study led by the American Cancer Society (ACS) has unveiled alarming new evidence: smoking menthol cigarettes significantly increases mortality risks compared to non-menthol cigarettes—particularly for cardiovascular diseases, including deadly heart conditions.
The research, published today in Tobacco Control, found that the danger extends beyond active smokers. Individuals who had quit smoking and those with high smoking intensities still faced elevated risks if they had previously smoked menthol brands. Most strikingly, Black participants currently smoking menthol cigarettes saw an 88% higher risk of death from certain heart diseases compared to those smoking non-menthol varieties.
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However, there is hope—the study reaffirmed that quitting smoking drastically lowers health risks, regardless of cigarette type. These findings add to the growing urgency for public health action against menthol tobacco products, reinforcing the critical need for cessation efforts and policy changes.
“Menthol in cigarettes is an established public health threat due to its effect on increasing smoking uptake and reducing smoking cessation,” said Dr. Priti Bandi, scientific director, 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. In the U.S. and globally in many low- and middle-income countries, the share of menthol cigarettes in the market is substantial.”
For the report, researchers followed nearly a million people from the Cancer Prevention Study II, a population-based prospective cohort enrolled in 1982-1983, and observed them for mortality outcomes over six years. All-cause and cause-specific mortality risk was assessed according to baseline smoking status (current, former, never) and menthol flavor status (menthol, non-menthol) of the cigarette brand smoked for the longest period.
Among 73,486 participants reporting menthol brands and 281,680 participants reporting non-menthol brands, there were 4,071 and 20,738 deaths, respectively. Participants currently smoking menthol or non-menthol cigarette brands had similarly high mortality risks compared to never smoking (e.g., death from any cause was about 2 times higher), but quitting substantially reduced the risk of death from both types of cigarettes. Among people who had quit smoking, a history of menthol versus non-menthol 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. Among individuals currently smoking, there was no difference in mortality risks for menthol vs. non-menthol cigarettes, except for an elevated risk among those smoking 40 or more cigarettes per day and in Black individuals for some heart diseases.
“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.”
