Pregnant females were excluded from the study groups
Co-authored by Rani Gorgis This article was co-authored by Rani Gorgis
While the precise mechanisms by which smoking increases cardiovascular disease are still being discovered, it has been shown to exert direct myocardial effects, such as increasing myocardial oxygen demand, lowering the threshold for angina, and Impairing exercise performance (Figure 2)

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Put another way: If people dont get hooked on cigarettes at a young age, they generally dont start to smoke
Thus, there is a general understanding of the neurobiological effects of menthol plus nicotine on the brain, which include enhancing nicotine reward, altering nicotinic acetylcholine receptor number and function, and altering midbrain neuron excitability 32