Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies
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BACKGROUND: The effect of passive smoking on the risk of coronary heart disease is controversial. We conducted a meta-analysis of the risk of coronary heart disease associated with passive smoking among nonsmokers. METHODS: We searched the Medline and Dissertation Abstracts Online data bases and reviewed citations in relevant articles to identify 18 epidemiologic (10 cohort and 8 case-control) studies that met prestated inclusion criteria. Information on the designs of the studies, the characteristics of the study subjects, exposure and outcome measures, control for potential confounding factors, and risk estimates was abstracted independently by three investigators using a standardized protocol. RESULTS: Overall, nonsmokers exposed to environmental smoke had a relative risk of coronary heart disease of 1.25 (95 percent confidence interval, 1.17 to 1.32) as compared with nonsmokers not exposed to smoke. Passive smoking was consistently associated with an increased relative risk of coronary heart disease in cohort 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 to 1.35), in women (relative risk, 1.24; 95 percent confidence interval, 1.15 to 1.34), and in those exposed to smoking at home (relative risk, 1.17; 95 percent confidence interval, 1.11 to 1.24) or in the workplace (relative risk, 1.11; 95 percent confidence interval, 1.00 to 1.23). A significant dose-response relation was identified, with respective relative risks of 1.23 and 1.31 for nonsmokers who were exposed to the smoke of 1 to 19 cigarettes per day and those who were exposed to the smoke of 20 or more cigarettes per day, as compared with nonsmokers not exposed to smoke (P=0.006 for linear trend). CONCLUSIONS: Passive smoking is associated with a small increase in the risk of coronary heart disease. Given the high prevalence of cigarette smoking, the public health consequences of passive smoking with regard to coronary heart disease may be important.
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The analysis did not investigate differences in effect sizes for SHS exposure at home versus at work.
“Previous studies have found different effect sizes for SHS exposure at home and at work442,443,462, a factor that was not investigated in our analysis.”
From Health effects associated with exposure to secondhand smoke: a Burden of Proof study (2024) · cites this paper as [442]
Accumulated evidence shows that passive smoking increases the risk of CHD, with a higher relative risk than might be expected.
“Accumulated evidence shows that passive smoking increases the risk of CHD, with a higher relative risk than might be expected.209,224,225”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [209]
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- Authors
- He, J., Vupputuri, S., Allen, K., Prerost, M. R., Hughes, J., & Whelton, P. K.
- Affiliations
- Tulane University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1999-03-25
- Volume
- 340
- Issue
- 12
- Pages
- 920-926
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2316007655
- Cited by
- 616
- References
- 51
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 6 · 2022: 9 · 2021: 8 · 2020: 9 · 2019: 22 · 2018: 21 · 2017: 39 · 2016: 21 · 2015: 25 · 2014: 26 · 2013: 41 · 2012: 31
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1p20es006435-01, 5r01hl060300-05)
- National Heart, Lung, and Blood Institute (HL60300)
- National Institute of Environmental Health Sciences (ES06435)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- passive smoking, environmental tobacco smoke, coronary artery disease, non-smokers, cardiovascular risk, dose-response relationship, sex differences
- MeSH terms
- Coronary Disease, Environmental Exposure, Female, Humans, Male, Risk, Risk Factors, Tobacco Smoke Pollution, Epidemiologic Studies
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