Secondhand Smoke Exposure and Cardiovascular Effects Making Sense of the Evidence (2010) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-30
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From page 15... ...
In 1972, the U.S. Office of the Surgeon General released its first statement on the public-health hazard to people suffering from coronary heart disease posed by secondhand smoke in The Health Consequences of Smoking (HHS, 1972)
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From page 16... ...
Their data provide evidence that limitation of secondhand-smoke exposure should reduce risk of mortality from coronary heart disease substantially. The high prevalence of secondhand smoke and consequently the increased risk of coronary heart disease in the U.S.
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From page 17... ...
; and 3. the association between smoking bans and acute coronary events (Questions 4, 5, 6, 7, and 8)
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From page 18... ...
I secondhand smoke exposure incident could precipitate an acute for exposure data, and for data on pathophysiologic effects of secondhand smoke that could underlie any acute coronary events that might be seen. The literature searches identified thousands of publications relevant to secondhand-smoke pathophysiology and health effects and relevant to smoking bans, from which the committee identified studies to be discussed in this report.
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From page 19... ...
Most of the studies do not measure individual exposures to secondhand smoke or the smoking status of individuals. Those studies, therefore, are designed to evaluate the association between smoking bans and heart attacks, not the effects of secondhand smoke exposure.
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From page 20... ...
, the committee also reviewed the scientific evidence and current scientific consensus on the association between secondhand-smoke exposure and cardiovascular disease in general (Question 1) and the evidence related to the biologic plausibility of a causal association between secondhand-smoke exposure and acute coronary events (Question 2)
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From page 21... ...
The committee presents information on air pollutants in this report relevant to the biologic plausibility of associations between secondhand smoke and cardiovascular disease, but it did not conduct an extensive literature review on the topic of air-pollutant health effects. SOuRCES OF uNCERTAINTy IN kEy STuDIES As discussed above, 11 publications report studies of the effect of smoking bans on the incidence of acute coronary events.
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From page 22... ...
. If a study does not look only at nonsmokers or does not determine the smoking status of people who have acute coronary events, it cannot separate decreases in acute coronary events in nonsmokers that are due to lowering of secondhand-smoke exposure from decreases that are due to smoking 1 Dr.
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From page 23... ...
Potential Health Outcomes • Acute coronary events triggered by short-term secondhand- • Decreases in the number of acute coronary events triggered by smoke exposure short-term or longer-term (e.g., full work day at office) • Subclinical conditions mediated by chronic exposure to secondhand-smoke exposure secondhand smoke that predispose an individual to acute • Gradual decrease in the number of individuals with subclinical coronary events conditions or in the severity of the subclinical conditions that predispose an individual to an acute coronary event due to decreased chronic exposure to secondhand smoke • Decreases in both the number of acute coronary events and predisposing conditions in smokers from decreased number of smokers and decreased number of cigarettes smoked by smokers FIGuRE 1-1 Factors that can affect the impact of smoking bans on cardiovascular outcomes.
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From page 24... ...
The time period is relevant to the mechanisms by which secondhand smoke could cause acute coronary events. The committee also examined time between exposure to particulate matter and cardiovascular 2 The distinction between effects in nonsmokers and effects in smokers is important for assessing the effects of secondhand-smoke exposure on acute coronary events, but not for assessing the effects of smoking bans on acute coronary events.
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From page 25... ...
An important aspect of the committee's charge to weigh the evidence of a causal association between secondhand-smoke exposure and acute coronary events is the biologic plausibility of the association. Evidence related to biologic plausibility comes from experimental studies of humans and other animals.
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From page 26... ...
A study could try to test several hypotheses related to secondhand-smoke exposure; each hypothesis might be best answered with a different study design, and each would be related to different questions being asked of this committee. A cohort study could test the hypothesis that long-term exposure to secondhand smoke increases the risk of coronary events, a "natural experimental" study could test the hypothesis that a long-term reduction in secondhand-smoke exposure leads to a reduced incidence of events, and an observational case-crossover study with detailed examination of the temporal relationships between exposure and episodes and detailed exposure assessment (a study similar, for example, to time-series studies of air pollution that looked at the relationship between exposures and acute coronary events)
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From page 27... ...
The information from those key studies as well as the pathophysiologic data and other epidemiologic studies discussed in Chapter 4 are then synthesized in Chapter 7. In Chapter 8, the committee summarizes its conclusions about the association between secondhand-smoke exposure and cardiovascular disease, secondhand-smoke exposure and acute coronary events, and smoking bans and acute coronary events, discussing the weight of evidence for the associations.
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From page 28... ...
2007. Declines in hospital admissions for acute myocardial infarction in New York state after implementation of a comprehensive smoking ban.
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From page 29... ...
2007. Reduced admissions for acute myocardial infarction as sociated with a public smoking ban: Matched controlled study.
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