Environmental Tobacco Smoke and Coronary Heart Disease Mortality in the United States—A Meta-Analysis and Critique

  title={Environmental Tobacco Smoke and Coronary Heart Disease Mortality in the United States—A Meta-Analysis and Critique},
  author={James E. Enstrom and Geoffrey C. Kabat},
  journal={Inhalation Toxicology},
  pages={199 - 210}
Several major meta-analyses have concluded that exposure to environmental tobacco smoke (ETS) increases the risk of coronary heart disease (CHD) by about 25% among never smokers. However, these reviews have excluded a large portion of the epidemiologic evidence on questionable grounds and have been inconsistent in the selection of the results that are included. We conducted an updated meta-analysis and critique of the evidence on ETS exposure and its relationship to death from CHD among never… 

Mortality risks associated with environmental tobacco smoke exposure in the United States.

  • Brian L. Rostron
  • Medicine
    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
  • 2013
An association between high ETS exposure and heart disease mortality risk among never-smokers during short-term mortality follow-up is found using U.S. national health survey data.

Second-hand Smoke, Cotinine Levels, and Risk of Circulatory Mortality in a Large Cohort Study of Never-Smokers

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  • P. LeeJ. Fry
  • Medicine
    Regulatory toxicology and pharmacology : RTP
  • 2011

Tobacco Industry Efforts Undermining Evidence Linking Secondhand Smoke With Cardiovascular Disease

The industry interest in preserving corporate viability has affected the design and interpretation of their cardiovascular studies, indicating the need for great caution in current debates about future tobacco industry regulation and development of reduced-harm tobacco products.

Second-hand smoke exposure in Canada: prevalence, risk factors, and association with respiratory and cardiovascular diseases.

Self-reported recent second-hand smoke exposure in Canada in 2000/2001 was high, and was associated with asthma, chronic bronchitis and hypertension in never- and ex-smokers.

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  • R. Edwards
  • Psychology, Medicine
    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
  • 2009
Using spousal smoking as a proxy of total second hand smoke exposure would have meant that subjects would have been misclassified as not exposed to secondhand smoke, which may bias estimates of association with health outcomes toward the null.

Challenges in Creating Evidence in Environmental Health Risk Assessments: The Example of Second-Hand Smoke

The main challenges for assessing the impact of a potential adverse health effect from an environmental pollutant are described and the example of SHS exposure highlights the need for evidence-based public health.

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There is an urgent need to develop smoking cessation interventions targeted specifically to the elderly, according to the Global Burden of Disease project, tobacco has the highest mortality risk of all substance use categories, especially for the elderly.



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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.

Publication bias in the environmental tobacco smoke/coronary heart disease epidemiologic literature.

Two approaches are used to assess publication bias in the environmental tobacco smoke/coronary heart disease (ETS/CHD) literature: statistical tests applied to all sex-specific relative risk estimates from 14 previously published studies indicate that publication bias is likely, and comparison of pooled relative risk figures indicates that published data overestimate the association of spousal smoking and CHD.

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Exposure to ETS exposure during adulthood increased the risk of myocardial infarction approximately 50% in this data although the findings were not statistically significant.

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Breathing other people's smoke is an important and avoidable cause of ischaemic heart disease, increasing a person's risk by a quarter, and platelet aggregation provides a plausible and quantitatively consistent mechanism for the low dose effect.

A prospective study of passive smoking and coronary heart disease.

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The results do not support a causal relation between environmental Tobacco smoke and tobacco related mortality, although they do not rule out a small effect, and the association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.

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Effects of passive smoking on ischemic heart disease mortality of nonsmokers. A prospective study.

The hypothesis that nonsmoking women exposed to their husband's cigarette smoke would have an elevated risk of fatal ischemic heart disease is compatible with the hypothesis that passive cigarette smoking carries an excess risk of fatalities.