Secondhand Smoke Exposure and Cardiovascular Effects Making Sense of the Evidence (2010) / Chapter Skim
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4 Epidemiologic Studies of Secondhand-Smoke Exposure and Cardiovascular Disease
4 Epidemiologic Studies of Secondhand-Smoke Exposure and Cardiovascular Disease
Pages 95-108
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From page 95... ...
Next is a discussion of the epidemiologic studies of secondhand-smoke exposure and chronic cardiovascular disease. Two other studies conducted following the implementation of smoking bans that address the association between secondhand smoke exposure and acute coronary events are discussed in Chapter 6.
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From page 96... ...
Like active smoking, exposure to secondhand smoke could be considered an independent risk factor for cardiovascular disease. EPIDEMIOLOGy OF CHRONIC ExPOSuRE TO SECONDHAND TOBACCO SMOkE IN RELATION TO CORONARy HEART DISEASE AND ACuTE CORONARy EvENTS The surgeon general's 2006 report concluded that "the evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and increased risks of coronary heart disease morbidity and mortality among both men and women" and that "pooled relative risks from metaanalyses indicate a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke" (HHS, 2006)
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From page 97... ...
estimates in individual studies were statistically significant. Several published meta-analyses of the epidemiologic studies pooled RR estimates from individual studies and showed a significant 25–30% increase in the risk of coronary heart disease associated with various exposures to secondhand smoke (Barnoya and Glantz, 2005; He et al., 1999; HHS, 2006; Law et al., 1997; Thun et al., 1999; Wells, 1994, 1998)
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From page 98... ...
in nonsmokers in the Greek population. A detailed questionnaire regarding exposure to secondhand smoke was completed by 848 patients with a first ACS event and 1,078 coronary heart disease-free matched controls.
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cholesterol, triglycerides, white-cell count, forced expiratory volume, and preexisting coronary heart disease (Whincup et al., 2004)
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Interviews included medical history and lifestyle habits, and personal lifetime exposure to secondhand smoke in the home, workplace and other public settings. Information was asked according to exposures younger than 21 years of age, and for each decade of adult life (21–30, 31–40, etc.)
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From page 101... ...
To the extent that the effects of secondhand-smoke exposure on CVD are due to recent exposures, cumulative exposure is an inappropriate exposure metric. Dose–Response Association A dose–response association between secondhand smoke and the risk of coronary heart disease was reported in several epidemiologic studies and meta-analyses (He et al., 1999; HHS, 2006)
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From page 102... ...
. However, that potential bias was unlikely to have a substantial effect on studies of secondhand smoke and coronary heart disease because the extent of such misclassification was minor and the RR of coronary heart disease in former smokers was not high (Hackshaw et al., 1997; Howard and Thun, 1999; Kawachi and Colditz, 1996)
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From page 103... ...
. Measurement errors due to failure to assess total secondhand-smoke exposures from different sources, failure to obtain repeated exposure data over time, or underreporting of exposures of nonsmokers would bias the association between secondhand smoke and coronary heart disease toward the null (Kawachi and Colditz, 1996)
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From page 104... ...
• A few epidemiologic studies using serum cotinine concentration, an objective measure of individual exposure to secondhand smoke, indicated that the RR of coronary heart disease associated with secondhand smoke was even greater than those estimates based on self-reported secondhand-smoke exposure. • The excess risk is unlikely to be explained by misclassification bias, uncontrolled confounding effects, or publication bias.
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From page 105... ...
2004. Environmental tobacco smoke and prevalent coronary heart disease among never smokers in the Scottish Monica surveys.
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1999. Why is environmental tobacco smoke more strongly associated with coronary heart disease than expected?
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1995. Publication bias in the environmental tobacco smoke/ coronary heart disease epidemiologic literature.
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1995. Passive smoking by self report and serum cotinine and the prevalence of respiratory and coronary heart disease in the Scottish Heart Health study.
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