Cited by 616Smoking Behavior and CessationCardiovascular Health and Risk FactorsCardiac Health and Mental Health

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Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies

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He, Jiang, Vupputuri, Suma, Allen, Krista, Prerost, Monica R., Hughes, Janet, Whelton, Paul K.·1999·New England Journal of Medicine

DOI 10.1056/nejm199903253401204

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Abstract

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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Authors: He, J., Vupputuri, S., Allen, K., Prerost, M. R., Hughes, J., & Whelton, P. K.
Affiliations: Tulane University (US)
ORCID: He, Jiang
Vupputuri, Suma
Whelton, Paul K.
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
DOI: 10.1056/nejm199903253401204
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 › Public Health, Environmental and Occupational Health › 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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Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies

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