Menthol cigarette smokers had a higher risk of dying from any health cause, including heart disease, compared to former non-menthol cigarette smokers, according to what researchers say is the largest and most comprehensive study of its kind.

Among former smokers, those who smoked menthol cigarettes showed:

• 12% higher risk of death from all causes
• 16% higher risk from cardiovascular diseases
• 13% higher risk from coronary artery disease
•  43% higher risk from other heart diseases

Mortality risks were shown to be especially high for individuals who quit smoking or smoked 40 or more menthol cigarettes per day. In addition, Black Americans who currently smoke menthol cigarettes face an 88% elevated risk of mortality from some heart diseases compared to those smoking non-menthol cigarettes, shows the study, which was published in the journal Tobacco Control [February 2025]. 

The alarming findings come at a critical time—just weeks after the FDA under the Trump administration withdrew a proposed Biden-era ban on menthol cigarettes and flavored cigars amid tobacco industry pressure. 

“These findings do not imply that non-menthol cigarettes are safer; mortality risks were highest for continued smoking of both menthol and non-menthol cigarettes for all studied causes, whereas quitting both types substantially lowered risk,” the researchers say.

“On the contrary, our findings of a unique excess mortality risk associated with menthol flavouring in cigarettes provide additional scientific evidence—apart from their known impacts on initiation and cessation—in support of the menthol flavour regulation in the USA and in [low- and middle-income countries].”

Menthol—naturally found in peppermint or made in a lab—makes tobacco products even more addictive and harder to quit. It alters how the brain senses taste and pain, creating a cooling effect that makes cigarette smoke feel smoother and easier to inhale.

“Menthol in cigarettes is an established public health threat due to its effect on increasing smoking uptake and reducing smoking cessation,” says lead author Dr. Priti Bandi, director of cancer risk factors and screening research at the American Cancer Society. “With these results additionally showing unique mortality effects, it’s time for menthol cigarettes to be regulated to help save lives.”

While smoking rates have declined in some groups, menthol cigarettes continue to rise in popularity, particularly among populations targeted by tobacco industry marketing, including Black Americans, women, and youth. Menthol cigarettes represented 36% of the market among major manufacturers in 2022—the highest percentage since reporting began in 1963.

The popularity of menthol extends beyond cigarettes, with about a quarter of middle and high school students who use flavored nicotine pouches choosing menthol pouches, and 93% of young adults (18-34 years old) who use flavored smokeless tobacco opting for mint or menthol varieties, according to the CDC.

For this report, researchers followed nearly a million people from the Cancer Prevention Study II, tracking their health over six years. Of the participants, 73,486 smoked menthol cigarettes and 281,680 smoked non-menthol cigarettes. In that time, 4,071 menthol smokers and 20,738 non-menthol smokers died.

The study fills a major evidence gap regarding additional disease risks conferred by menthol flavouring in cigarettes, the researchers say. They suggested the additional health risks of menthol may be more difficult to detect while someone is currently smoking given the severe harms of tobacco itself. 

They also found:

• Both menthol and non-menthol smokers had similar mortality risks, about twice as high as those who never smoked. However, quitting smoking significantly reduced the risk of death for both groups.
• Current menthol smokers had similar mortality risks to non-menthol smokers, except for those smoking 40 or more cigarettes per day, and for Black individuals, who experienced significantly higher risks for some heart diseases.

Federal law in the U.S. does not allow tobacco companies to sell cigarettes with added flavors except for menthol and regular tobacco flavors, but some states have added restrictions on flavored tobacco sales. 

Tobacco companies, meanwhile, have downplayed the health risks of menthol and increased nicotine levels in some menthol cigarettes. They are also creating new “non-menthol” products that are similar to menthol cigarettes but use different chemicals to create the same effect.

Lisa A. Lacasse, president of the ACS Cancer Action Network, urged policymakers to take action. She called for stronger anti-smoking laws, bans on menthol and flavored tobacco products, and better access to quit-smoking programs. She also emphasized the need for higher tobacco taxes and smoke-free laws to protect public health. 

“Today’s study proves once again why policymakers need to enact comprehensive policies that help individuals who currently use quit and prevent youth and young adults from becoming addicted to tobacco products,” she says.

Reference

Bandi P, Newton C, Xue Z, et al. Association of menthol-flavoured cigarette smoking with all-cause and cause-specific mortality risk. Tobacco Control. Published online February 13, 2025. doi:10.1136/tc-2024-059020