BACKGROUND: Despite a decline in cigarette smoking, cigar smoking is increasing, partly due to the perception that it is a "safe" alternative to cigarettes. However, cigar smoking increases cardiovascular risk, but the mechanisms involved are not fully explored. Aortic stiffness and arterial wave reflection are important factors for the efficient performance of the cardiovascular system and have been identified as prognosticators of cardiovascular risk. We investigated the acute effect of cigar smoking on aortic elastic properties and wave reflection. METHODS: We studied the effect of smoking one cigar in 12 healthy subjects according to a randomized, sham procedure-controlled, cross-over design. Aortic stiffness was evaluated with carotid-femoral pulse wave velocity and wave reflection with augmentation index of the aortic pressure waveform. RESULTS: Cigar smoking produced a significant increase in pulse wave velocity (by 0.80 m/sec, P = .001) denoting an increase in aortic stiffness. Augmentation index increased significantly (by 6.1%, P < .05) denoting an increase of wave reflections. These increases in arterial stiffness indices were evident promptly after the initiation of cigar smoking and lasted throughout the duration of the study (2 h). Concurrently, both radial and aortic systolic, and pulse pressure increased significantly throughout the study. CONCLUSIONS: The present study shows for the first time that cigar smoking increases acutely stiffness of large arteries and wave reflection, thus providing further evidence that it is not a safe alternative to cigarettes.