Background The effect of passive smoking on the risk of coronaryheart disease is controversial. We conducted a meta-analysisof the risk of coronary heart disease associated with passivesmoking among nonsmokers.
Methods We searched the Medline and Dissertation Abstracts Onlinedata bases and reviewed citations in relevant articles to identify18 epidemiologic (10 cohort and 8 case–control) studiesthat met prestated inclusion criteria. Information on the designsof the studies, the characteristics of the study subjects, exposureand outcome measures, control for potential confounding factors,and risk estimates was abstracted independently by three investigatorsusing a standardized protocol.
Results Overall, nonsmokers exposed to environmental smoke hada relative risk of coronary heart disease of 1.25 (95 percentconfidence interval, 1.17 to 1.32) as compared with nonsmokersnot exposed to smoke. Passive smoking was consistently associatedwith an increased relative risk of coronary heart disease incohort studies (relative risk, 1.21; 95 percent confidence interval,1.14 to 1.30), in case–control studies (relative risk,1.51; 95 percent confidence interval, 1.26 to 1.81), in men(relative risk, 1.22; 95 percent confidence interval, 1.10 to1.35), in women (relative risk, 1.24; 95 percent confidenceinterval, 1.15 to 1.34), and in those exposed to smoking athome (relative risk, 1.17; 95 percent confidence interval, 1.11to 1.24) or in the workplace (relative risk, 1.11; 95 percentconfidence interval, 1.00 to 1.23). A significant dose–responserelation was identified, with respective relative risks of 1.23and 1.31 for nonsmokers who were exposed to the smoke of 1 to19 cigarettes per day and those who were exposed to the smokeof 20 or more cigarettes per day, as compared with nonsmokersnot exposed to smoke (P=0.006 for linear trend).
Conclusions Passive smoking is associated with a small increasein the risk of coronary heart disease. Given the high prevalenceof cigarette smoking, the public health consequences of passivesmoking with regard to coronary heart disease may be important.
Source Information
From the Department of Biostatistics and Epidemiology (J. He, S.V., K.A., M.R.P., J. Hughes, P.K.W.) and the Prevention Research Center (J. He, J. Hughes, P.K.W.), Tulane University School of Public Health and Tropical Medicine, New Orleans.
Address reprint requests to Dr. He at the Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Ave., SL18, New Orleans, LA 70112, or at jhe{at}mailhost.tcs.tulane.edu.
Passive Smoking and Coronary Heart Disease
Swanson G. D., Denson K. W.E., Wells A. J., Jamrozik K., Colditz G. A., Fuster V., Greenland P., Liu K., Rabinoff M., He J., Hughes J., Whelton P. K., Bailar J. C.
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N Engl J Med 1999;
341:697-700, Aug 26, 1999.
Correspondence
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