Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Sep 18, 2023; 11(6): 290-312
Published online Sep 18, 2023. doi: 10.13105/wjma.v11.i6.290
Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions
Peter Nicholas Lee, Katharine J Coombs, Jan S Hamling
Peter Nicholas Lee, Katharine J Coombs, Jan S Hamling, Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
Author contributions: Lee PN planned the study; Literature searches were carried out by Coombs KJ and by Lee PN; Statistical analyses were carried out by Hamling JS and checked by Lee PN; Lee PN drafted the text, which was checked by Coombs KJ and Hamling JS.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peter Nicholas Lee, MA, Senior Statistician, Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton SM2 5DA, Surrey, United Kingdom. peterlee@pnlee.co.uk
Received: June 23, 2023
Peer-review started: June 23, 2023
First decision: August 4, 2023
Revised: August 14, 2023
Accepted: August 21, 2023
Article in press: August 21, 2023
Published online: September 18, 2023
Processing time: 81 Days and 18 Hours
Core Tip

Core Tip: Recent North American and European studies indicate that current, compared to never cigarette smoking, increases risk in each sex by about 3-fold for acute myocardial infarction, about 2-fold for ischaemic heart disease (IHD), and about 1.6-fold for stroke. More limited evidence from Japanese studies suggests a similar increase in risk for IHD, but a lower increase, of about 1.2-fold, for stroke. The increase in risk is greater in heavier smokers. Limited recent data for cigar or pipe smoking, all from North America, finds no evidence of an increased risk of IHD or stroke, one study reporting a significantly reduced risk of stroke in exclusive pipe smokers. Our findings are generally consistent with evidence from earlier studies. Cigarette smoking increases risk of all the three diseases studied, but by a much smaller factor than noted for lung cancer and chronic obstructive pulmonary disease in our companion publication. Any increase in risk from cigar and pipe smoking has not been demonstrated.