Smoking menthol cigarettes may more than double the risk for stroke compared to smoking other types of cigarettes, particularly for women and non-black smokers, according to a new large study.

Researchers analyzed data from a federal health survey that consisted of 5,167 current smokers in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2008, and found that those who reported smoking menthol cigarettes were more than twice as likely to have had a history of stroke compared to participants who smoked non-menthol cigarettes, according to lead researcher Dr. Nicholas Vozoris of St. Michael's Hospital and Queen's University in Toronto.

Vozoris indicated that there was an increased risk of 2.25 times for a history of stroke in menthol smokers compared to smokers who had other cigarettes, and he found that the difference was amplified among women and whites.

Women who smoked menthol cigarettes were 3.28 times and non-blacks were 3.48 times more likely to have a history of stroke compared to their respective counterparts.

"These results highlight the need for further review of the last legally allowed tobacco additive in North America, given that mentholated cigarettes may be placing individuals at even greater risk of potentially devastating cerebrovascular disease than regular cigarettes," Vozoris wrote.

However, researchers did not find an elevated risk between smoking menthol cigarettes and high blood pressure, heart attack, heart failure and lung disease chronic obstructive pulmonary disease.

"A possible explanation is that mentholated cigarettes exert some selective effects on the cerebrovascular system," Vozoris wrote, and cited past research that found that menthol cigarette smokers had increased carotid artery stiffness, while both menthol and non-menthol cigarette smoking had the similar effects on coronary artery reserve flow.

Vozoris noted while there is an association, stroke might not have been caused by smoking menthol cigarettes, but could be because smokers choosing menthol cigarettes may have already a higher baseline risk for stroke or are less likely to have medical therapy to prevent stroke.

Shortly after the U.S. Food and Drug Administration began regulating the tobacco industry under the 2009 Family Smoking Prevention and Tobacco Control Act, the agency banned most flavored cigarettes, like sweet-flavored clove cigarettes, but had exempted menthol cigarettes while it studied whether it posed more risks.

However, a FDA advisory panel determined in March 2011 that menthol cigarettes were indeed more harmful and had concluded that it was "biologically plausible" that adding menthol to cigarettes made them more addictive and harder to quit.

The panel had said that menthol was more than just a flavoring agent because it has "drug‐like characteristics that modulate the effects of nicotine on the smoker," by providing a "throat grab" sensory stimulation that could provide greater reinforcement of smoking behavior.

"The implications of these findings are that by reducing the harshness of tobacco smoke, menthol could facilitate initiation or early persistence of smoking by youth," the committee wrote in its report. "Also, by reducing the harshness of smoke, menthol could facilitate deeper and more prolonged inhalation of tobacco smoke, resulting in greater smoke intake per cigarette."

However, there still wasn’t enough evidence to indicate that menthol cigarette smokers were at higher risk of disease compared to other smokers, and the FDA has yet to take any action against menthol in cigarettes.

While the latest study highlights the potential health risks associated with smoking menthol cigarettes, experts maintain that other types of cigarettes are still dangerous and not much safer.

"There is no 'good' cigarette type," Vozoris told USA Today. "Smoking any kind of cigarette is bad for one's health, and serves to increase one's risk for a variety of cancers, heart diseases and lung diseases. However, this study shows that smoking mentholated cigarettes may place one at even higher risk for stroke than smoking regular, non-mentholated cigarettes."

The study was published in Archives of Internal Medicine on Monday.

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