issue Summer 2023

Through The Microscope: Illuminating the Impact of Menthol Cigarettes on Cardiovascular Health

By Nancy C. Jao, PhD
Photo by Michael R. Schmidt

Through the Microscope is a reoccurring Helix column that poses questions to members of the RFU community. Nancy C. Jao, PhD, was asked to detail her research on the impacts of menthol use in tobacco products.

Cardiovascular disease remains the leading cause of death in the United States, with cigarette smoking accounting for one-third of cardiovascular disease-related deaths. While overall cigarette smoking is decreasing, the use of menthol cigarettes continues to raise concerns.

The U.S. Food and Drug Administration (FDA) has long considered banning menthol as a characterizing flavor in cigarettes due to its role in smoking initiation and smoking-related deaths. Menthol reduces the harshness and irritation from smoking, making it easier for individuals to start and continue smoking. As menthol suppresses nicotine processing, individuals who smoke menthols also often have a harder time quitting smoking. Due largely to targeted marketing by tobacco companies to minority and vulnerable groups, menthol cigarettes also contribute to tobacco-related health disparities.

Inflammation plays a significant role in the development and progression of smoking-related cardiovascular diseases, making it one of the top priorities of the FDA’s Tobacco Regulatory Science Program. Cigarette smoke contains harmful chemicals that cause damage to blood vessels and trigger immune responses, leading to elevated biological markers of inflammation throughout the body. Elevations in these biomarkers are even detectable in individuals without visible symptoms, thus serving as early indicators of cardiovascular disease risk.

“While the clinical field has largely moved to focus on the rise of e-cigarette use, it is still essential to remain mindful of menthol cigarette use.”

Studies on cellular and animal models have demonstrated that menthol flavoring can increase inflammatory response and dysfunction beyond the effects of smoking. However, limited research has explored whether menthol cigarette use also exacerbates cardiovascular damage by elevating system-wide inflammation in people who smoke.

Additionally, while a federal ban on menthol cigarettes would likely reduce overall use in the U.S., studies indicate that 25–50% of individuals who smoke menthols plan to switch to non-menthol cigarettes instead of quitting or switching to non-combustible products (e.g., e-cigarettes). It remains unclear whether switching from menthol to non-menthol cigarettes would have any benefit by reducing systemic inflammation.

As the Principal Investigator of the Health, Behaviors, and Tobacco Use (HaBiT) Research Lab at RFU, our lab’s goal is to contribute to the development of clinical treatments and regulatory policies for tobacco products. Funded by the National Institutes of Health (NIH) and the FDA, our current five-year grant focuses on understanding the health effects of menthol cigarettes on inflammation and cardiovascular health. We will collect original data at the RFU Health Clinics by enrolling individuals who smoke menthol cigarettes in a five-week research study to examine potential changes in systemic inflammation biomarkers as they switch products. Through a smartphone app, we will gather real-time information to understand how behaviors, mood and perceptions may also change during a potential menthol cigarette ban.

While the clinical field has largely moved to focus on the rise of e-cigarette use, it is still essential to remain mindful of menthol cigarette use. It is important for both researchers and clinicians to note that cigarettes are not a uniform category, and that the type of cigarette an individual uses may have specific implications for their health and ability to quit smoking. By examining the impact of menthol on sensitive clinical measurements and chronic diseases, we hope to better understand the potential health implications of tobacco control policies.

Dr. Nancy C. Jao is an assistant professor and clinical psychologist in the Department of Psychology at RFU.

Perspectives expressed in “Through the Microscope” columns are solely those of the authors and are not intended to represent those of Rosalind Franklin University.