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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