Epidemiologic Studies of Fatal and Nonfatal Cardiovascular Disease and ETS Exposure from Spousal Smoking

Abstract

This article reviews the epidemiologic studies of the association of ischemic heart disease risk and environmental tobacco smoke (ETS) exposure from a spouse who smokes. Seventeen studies (nine cohort, eight case-control) comprising more than 485,000 lifelong nonsmokers and 7,345 coronary heart disease (CHD) events were included in a meta-analysis. Together, these studies include 36% more CHD events and 58% more study subjects than were available for review by the U.S. Occupational Safety and Health Administration (OSHA) in 1994. The relative risk (RR) for fatal or nonfatal coronary events among never smokers married to smokers, compared to those whose spouses did not smoke, was RR = 1.25 (95% confidence interval [95% Cl], 1.17-1.33) across the combined studies. This association was statistically similar in men (RR = 1.24; 95% Cl, 1.15-1.32) and women (RR = 1.23; 95% Cl, 1.15-1.32); in studies of cohort (RR = 1.23; 95% Cl, 1.15-1.31) and case-control (RR = 1.47; 95% Cl, 1.19-1.81) design; in the United States (RR =1.22; 95% Cl, 1.13-1.30) and other countries (RR = 1.41; 95% Cl, 1.21-1.65); and in studies of fatal (RR = 1.22; 95% Cl, 1.14-1.30) and nonfatal (RR = 1.32; 95% Cl, 1.04-1.67) heart disease. In three studies that presented data separately for nonsmokers married to current or former smokers, the association was stronger when the spouses continued to smoke (RR = 1.16, 1.06-1.28) than with former smokers (RR = 0.98; 95% Cl, 0.89-1.08). The aggregate data are unlikely to be attributable to chance, publication bias, confounding, or misclassification of exposure. The evidence linking heart disease and ETS exposure from a spouse has become substantially stronger since OSHA first proposed including heart disease in its risk assessment of ETS in 1994. Key words: environmental tobacco smoke, heart disease. -Environ Health Perspect 107(suppl 6):841-846 (1999). http.//ehpnetl.niehs.nih.gov/docs/1999/suppl6/84 1-846thun/abstract. html

Effects of passive smoking on heart rate variability, heart rate and blood pressure: an observational study

“…[5][6][7][8][9][10][25][26][27] Our study provides further evidence that ETS exposure is associated with cardiac autonomic dysregulation, which may be an intermediate step in the pathway to cardiac instability. 4,28 Our observations are in agreement with the findings of Pope, who described a short-term decrease in all HRV domains after acute exposure to ETS, but with relatively high standard errors in HF.…”

“…[5][6][7][8][9][10] HRV, a widely used measure of cardiac autonomic control, 11 reflects autonomic modulation of the rhythmic activity of the sinus node. 11 To date, little has been reported on the association between ETS exposure and HRV, heart rate, or blood pressure, the alterations of which may be steps in the pathophysiological pathway leading from ETS exposure to cardiopulmonary disease.…”

Acute exposure to environmental tobacco smoke and heart rate variability.

“…Exposure to environmental tobacco smoke (ETS) has been associated with cardiovascular disease and death (1)(2)(3)(4)(5)(6)(7)(8). Potential pathophysiologic pathways leading from ETS exposure to cardiopulmonary disease are still being explored (5,9), but there has been a growing recognition of the importance of the autonomic nervous system in cardiovascular disease (10).…”

Tobacco Industry Efforts Undermining Evidence Linking Secondhand Smoke With Cardiovascular Disease

“…60,61 The NMFS data set also had exposure misclassification and design problems: Information on smoking was obtained from next of kin by mail; the comparison group included only deceased persons; and a disproportionate number of ethnic minorities and young people had died. 7,62 The industry ignored these problems, instead concentrating on the fact that these studies were based on large data sets. When a 1995 review was published in the Journal of the American Medical Association 10 updating the conclusion that SHS caused heart disease, the Tobacco Institute issued a statement criticizing the review by stating that "the two largest and most representative studies" did not support the review's conclusions and had been ignored by the authors.…”