That seems to be particularly true for women and non-African Americans.

The study's author said that although no cigarettes are good for you, the new findings suggest people should especially move away from mentholated types.

"They're all bad, but having said that, from a harm-reduction perspective this study does lend to the view of avoiding -- at a minimum -- mentholated cigarettes," said Dr. Nicholas Vozoris, a clinical associate at St. Michael's Hospital in Toronto.

Menthol is added to cigarettes to give them a peppermint and "refreshing" flavor.

For the new study, Vozoris used information taken from U.S. health and lifestyle surveys that included 5,028 adult smokers. The surveys were conducted in 2001 through 2008.

Overall, about 26 percent of those participants said they usually smoked mentholated cigarettes, and the rest smoked non-mentholated ones.

Of menthol smokers, 3.4 percent said on the surveys they'd had a stroke, which usually occurs when a clot blocks blood flow to the brain. That compared to 2.7 percent of the non-menthol smokers.

After taking into account smokers' age, race, gender and number of cigarettes smoked, Vozoris found mentholated cigarette smokers had more than double the risk of stroke compared to those who opted for non-mentholated cigarettes.

The difference was especially clear in women and people who reported a race other than African American on their surveys: Among those study participants, strokes were over three times more common in menthol smokers.

Vozoris told Reuters Health that women and non-African Americans seemed to be driving the link between mentholated cigarettes and strokes, but he wasn't sure why. The study can't answer this question either.

It also can't prove that the mentholated cigarettes, themselves, caused the extra stroke risk, rather than some unmeasured difference between menthol and non-menthol smokers.

Choosing mentholated cigarettes wasn't tied to an increased risk of high blood pressure, congestive heart failure, chronic lung disease or heart attack compared to standard cigarettes.

It's interesting that the study showed an association between smoking mentholated cigarettes and strokes but not high blood pressure, according to Dr. Gordon Tomaselli, president of the American Heart Association and chief of cardiology at Johns Hopkins University School of Medicine in Baltimore.

Vozoris, whose findings are published in the Archives of Internal Medicine, said it's possible the menthol in cigarettes has an effect on the blood vessels that supply the brain in particular.

Last year, an advisory committee to the U.S. Food and Drug Administration said taking mentholated cigarettes off the shelves may benefit public health. (See Reuters story of March 18, 2011.)

Some say menthol makes it easier to start smoking and harder to quit because its taste masks the harshness of tobacco. But manufacturers disagree.

According to the U.S. Centers for Disease Control and Prevention, smoking any type of cigarettes increases a person's risk of heart disease two- to four-fold compared to non-smokers.

Tomaselli, who wasn't involved in the new study, told Reuters Health it "reminds us that the effects of cigarette smoke is pretty broad-based and (it affects) a number of organ systems."

SOURCE: bit.ly/I6DHPs Archives of Internal Medicine, online April 9, 2012.

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