Wednesday, June 18, 2014

Stroke Risk Same for Menthol and Nonmenthol Smokers

Dr. Nicholas Vozoris in 2012 reported that “…smokers of mentholated cigarettes, and in particular women and non–African Americans, have significantly increased odds of stroke compared with nonmentholated cigarette smokers.”  (reference here).  He used National Health and Nutrition Examination Surveys (NHANES) data to calculate odds ratios of 2.3 for all menthol smokers, 3.3 for women and 3.5 for non-African Americans.  Dr. Vozoris found no increased risk for hypertension, heart attack, congestive heart failure or emphysema among menthol smokers. 

If the Vozoris findings on menthol and stroke were independently confirmed, they could serve as a basis for a ban on menthol cigarettes.  Instead, an analysis of NHANES data by Dr. Brian Rostron (here) comes to an entirely different conclusion.

Dr. Rostron found that African-American menthol smokers had a significantly lower risk for stroke (OR = 0.52, 95% confidence interval= 0.28 – 0.99) than nonmenthol smokers.

“It is not clear to me,” Dr. Rostron writes, “how Vozoris obtained his findings, given that I cannot replicate his general results for stroke using the NHANES data and analyses that he specified.  Moreover, the absence of observed differences in stroke prevalence among NHANES menthol smokers would suggest that methodological or analytical issues may have affected his results.”

Dr. Rostron earlier showed that menthol smokers have lower lung cancer risks than nonmenthol smokers (here).

Promoted by the Archives of Internal Medicine (here), the Vozoris study was covered by major news media (here  and here).  The journal, which changed its name to JAMA Internal Medicine in January 2013, is not publicizing the study that corrects the deficient 2012 analysis.

Although medical journals cannot avoid publishing erroneous reports, editors should take all measures to correct the types of mistakes discovered by Rostron.

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