Cigarette smoking represents the single most important preventable cause
of death in the United States.1 Studies that
document the effect of cigarette smoke on the progression of the atherosclerotic
process add to the overwhelming evidence that tobacco smoke is an atherogenic
agent. The morbidity and mortality secondary to tobacco smoke have been dismissed
by the tobacco industry because smokers have a choice in whether they smoke
and are generally aware of the risks associated with smoking. However, this
argument does not extend to the millions of people who are exposed to tobacco
smoke not as active smokers but by inhalation of environmental tobacco smoke
(ETS). The public health impact of ETS is thought to be considerable. Of the
estimated 480000 smoking-related deaths that occur every year in the United
States, 53000 have been attributed to ETS, making passive smoke the third
leading preventable cause of death, after active smoking and alcohol use.2 Recent epidemiologic evidence shows that never smokers
exposed to ETS have an increased risk not only of lung cancer but also of
cardiovascular disease (CVD). Two recent prospective trials3,4
and meta-analyses2,5 estimate
the relative risk for CVD at 1.2 to 1.3 for individuals exposed to ETS. Of
the deaths caused by ETS, the number of deaths from heart disease is about
3 times the number of noncardiac deaths.2
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