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January 1, 1992, Vol 267, No. 1 >
ARTICLE | January 1, 1992

Passive Smoking and the Risk of Heart Disease FREE

Kyle Steenland, PhD
[+] Author Affiliations

Reprint requests to the National Institute for Occupational Safety and Health, Mailstop R13, 4676 Columbia Pkwy, Cincinnati, OH 45226 (Dr Steenland).


JAMA. 1992;267(1):94-99. doi:10.1001/jama.1992.03480010102033
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References

Objective.  —This paper reviews the evidence that exposure to environmental tobacco smoke (ETS) increases the risk of heart disease death among persons who have never smoked (never-smokers). The annual number of heart disease deaths in the United States attributable to ETS is estimated, as is the individual risk of heart disease death for exposed never-smokers.

Data Sources.  —Nine epidemiologic studies and numerous experimental studies are available to evaluate the association of ETS and heart disease.

Data Synthesis.  —The relative risk for never-smokers living with current or former smokers, compared with never-smokers living with nonsmokers, has ranged from 0.9 to 3.0 in nine studies. Seven studies were positive, one was positive for women but not men, and one was negative. Several studies have shown a dose-response relationship and have controlled for other risk factors. Evidence from experimental studies suggests that ETS can damage the cardiovascular system, via both short-term and long-term mechanisms. Assuming that the observed heart disease risk for those exposed to ETS is not an artifact of misclassification or confounding, approximately 35000 to 40000 deaths from ischemic heart disease among never-smokers and long-term former smokers are estimated to have occurred annually in the United States as a result of ETS exposure in the early 1980s. An individual male never-smoker living with a current or former smoker is estimated to have an approximately 9.6% chance of dying of ischemic heart disease by the age of 74 years, compared with a 7.4% chance for a male never-smoker living with a nonsmoker. The corresponding lifetime risks for women are 6.1% and 4.9%.

Conclusions.  —The public health burden due to ETS exposure is likely to be much greater for heart disease than for lung cancer, which has been the focus of most debate to date. Individual lifetime excess risks of heart disease death due to ETS of one to three per 100 can be compared with much lower excess risks of one death per 100 000, which are often used in determining environmental limits for other toxins. Exposure to ETS is not currently regulated at the federal level, except for domestic air traffic.(JAMA. 1992;267:94-99)

REFERENCES

1 +
National Research Council. Environmental Tobacco Smoke: Measuring Exposure and Assessing Health Effects . Washington, DC: National Academy Press; 1986;.
2 +
Health Effects of Passive Smoking: Assessment of Lung Cancer in Adults and Respiratory Disorders in Children . Washington, DC: Environmental Protection Agency; May 1990;. Publication EPA/ 600/6-90/006A, review draft.
3 +
Hammond S, Leaderer B.  A diffusion monitor to measure exposure to passive smoking. Environ Sci Technol . 1987;;21:494-497.
4 +
Repace J.  Exposure assessment in passive smoking.  In: Environmental Tobacco Smoke: A Compendium of Information . Washington, DC: Indoor Air Division, Environmental Protection Agency; 1989;.
5 +
Cummings K, Mahoney M, Bhargava A.  Measurement of current exposure to environmental tobacco smoke. Arch Environ Health . 1990;;45:75-79.
6 +
Haley N, Colosimo S, Axelrad C, et al.  Biochemical validations of self-reported exposure to ETS. Environ Res . 1989;;49:127-135.
7 +
Wald N, Ritchie C.  Validation of studies on lung cancer in nonsmokers married to smokers. Lancet . 1984;;1:1067.
8 +
Husgafvel-Pursiainen K, Sorsa M, Engstrom K, et al.  Passive smoking at work: biochemical and biological measures of exposure to ETS. Int Arch Occup Environ Health . 1987;;59:337-345.
9 +
Surgeon General. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1986;.
10 +
Helsing K, Sandler D, Comstock G, et al.  Heart disease mortality in nonsmokers living with smokers. Am J Epidemiol . 1988;;127:915-922.
11 +
Hole D, Gillis C, Chopra C.  Passive smoking and cardiorespiratory health in a general population in the west of Scotland. BMJ . 1990;;299:423-427.
12 +
Humble C, Croft J, Gerber A, et al.  Passive smoking and 20-year cardiovascular disease mortality among nonsmoking wives, Evans County, Georgia. Am J Public Health . 1990;;80:599-601.
13 +
Lee P, Chamberlain J, Alderson M.  Relationship of passive smoking to risk of lung cancer and other smoking-associated diseases. Br J Cancer . 1986;;54:97-105.
14 +
He Y.  Women's passive smoking and coronary heart disease. Chin J Prev Med . 1989;;23:19-22.
15 +
Dobson A, Alexander H, Heller R, et al.  Passive smoking and the risk of heart attack or coronary death. Med J Aust . 1991;;154:793-797.
16 +
Svendsen K, Kuller L, Martin M, et al.  Effects of passive smoking in the Multiple Risk Factor Intervention Trial. Am J Epidemiol . 1987;;126:783-795.
17 +
Garland C, Barrett-Connor E, Suarez L, et al.  Effects of passive smoking on ischemic heart disease mortality of nonsmokers. Am J Epidemiol . 1985;;121:645-649.
18 +
Hirayama T.  Lung cancer in Japan: effects of nutrition and passive smoking.  In: Mizell M, Correa P, eds. Lung Cancer: Causes and Prevention . New York, NY: Verlag Chemie International; 1984;.
19 +
Glantz S, Parmley W.  Passive smoking and heart disease. Circulation . 1991;;83:1-12.
20 +
Surgeon General. The Health Consequences of Smoking: Cardiovascular Disease: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1983;.
21 +
Marchand L, Wilkens L, Hankin J, et al.  Dietary patterns of female nonsmokers with and without exposure to environmental tobacco smoke. Can Causes Control . 1991;;2:11-16.
22 +
Sidney S, Caan B, Friedman G.  Dietary intake of carotene in nonsmokers with and without passive smoking at home. Am J Epidemiol . 1989;;129: 1305-1309.
23 +
Allred E, Bleecker E, Chaitman B, et al.  Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med . 1989;;321:1426-1475.
24 +
Sheps D, Herbst M, Hinderliter A, et al.  Production of arrhythmias by elevated COHb in patients with coronary artery disease. Ann Intern Med . 1990;;113:343-351.
25 +
Stern F, Halperin W, Hornung R.  Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide. Am J Epidemiol . 1988;;128:1276-1288.
26 +
Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1990;.
27 +
Feldman J, Shenker I, Etzel R, et al.  Passive smoking alters lipid profiles in adolescents. Pediatrics . 1991;;2:259-264.
28 +
Repace J, Lowery A.  Risk assessment methodologies for passive smoking-induced lung cancer. Risk Anal . 1990;;10:27-37.
29 +
Kleinbaum K, Kupper L, Morganstern H. Epidemiologic Research . San Jose, Calif: Lifetime Learning Publications; 1983;.
30 +
Vainio H, Partanen T.  Population burden of lung cancer due to environmental tobacco smoke. Mutat Res . 1989;;222:137-140.
31 +
Wald N, Nanchahal K, Thompson S, et al.  Does breathing other people's tobacco smoke cause lung cancer? BMJ . 1986;:293:1217-1222.
32 +
Kabat G, Wynder E.  Lung cancer in nonsmokers. Cancer . 1984;;53:1214-1221.
33 +
Humble C, Samet J, Pathak D.  Marriage to a smoker and lung cancer risk. Am J Public Health . 1987;;77:598-602.
34 +
Garfinkel L, Auerbach O, Joubert L.  Involuntary smoking and lung cancer: a case-control study. J Natl Cancer Inst . 1985;;75:463-469.
35 +
Correa P, Pickle L, Fontham E, et al.  Passive smoking and lung cancer. Lancet . 1983;;2:595-597.
36 +
Stellman S, Garfinkel L.  Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women. J Natl Cancer Inst . 1986;;76:1057-1063.
37 +
Rogot E, Murray J.  Smoking and causes of death among US veterans: 16 years of observation. J Natl Cancer Inst . 1980;;95:213-222.
38 +
Beeson W, Mills P, Roland P, et al.  Chronic disease among Seventh-Day Adventists, a low-risk group. Cancer . 1989;;64:570-581.
39 +
Colditz G, Willett A, Stampfer M, et al.  A prospective study of parental history of myocardial infarction and coronary heart disease in women. Am J Epidemiol . 1986;;123:48-58.
40 +
Brackbill R, Frazier T, Shilling S.  Smoking characteristics of US workers, 1978-1980. Am J Ind Med . 1988;;13:5-41.
41 +
Gail M.  Measuring the benefits of reduced exposure to environmental carcinogens. J Chron Dis. 1975;;28:135-147.
42 +
Axelson O.  Aspects on confounding in occupational epidemiology. Scand J Work Environ Health . 1978;;4:85-89.
43 +
Rodericks J, Brett S, Wrenn G.  Significant risk decisions in federal regulatory agencies. Regul Toxicol Pharmacol . 1987;;7:307-320.
44 +
Wells A.  An estimate of adult mortality from passive smoking. Environ Int . 1988;;14:249-265.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Research Council. Environmental Tobacco Smoke: Measuring Exposure and Assessing Health Effects . Washington, DC: National Academy Press; 1986;.
2 +
Health Effects of Passive Smoking: Assessment of Lung Cancer in Adults and Respiratory Disorders in Children . Washington, DC: Environmental Protection Agency; May 1990;. Publication EPA/ 600/6-90/006A, review draft.
3 +
Hammond S, Leaderer B.  A diffusion monitor to measure exposure to passive smoking. Environ Sci Technol . 1987;;21:494-497.
4 +
Repace J.  Exposure assessment in passive smoking.  In: Environmental Tobacco Smoke: A Compendium of Information . Washington, DC: Indoor Air Division, Environmental Protection Agency; 1989;.
5 +
Cummings K, Mahoney M, Bhargava A.  Measurement of current exposure to environmental tobacco smoke. Arch Environ Health . 1990;;45:75-79.
6 +
Haley N, Colosimo S, Axelrad C, et al.  Biochemical validations of self-reported exposure to ETS. Environ Res . 1989;;49:127-135.
7 +
Wald N, Ritchie C.  Validation of studies on lung cancer in nonsmokers married to smokers. Lancet . 1984;;1:1067.
8 +
Husgafvel-Pursiainen K, Sorsa M, Engstrom K, et al.  Passive smoking at work: biochemical and biological measures of exposure to ETS. Int Arch Occup Environ Health . 1987;;59:337-345.
9 +
Surgeon General. The Health Consequences of Involuntary Smoking: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1986;.
10 +
Helsing K, Sandler D, Comstock G, et al.  Heart disease mortality in nonsmokers living with smokers. Am J Epidemiol . 1988;;127:915-922.
11 +
Hole D, Gillis C, Chopra C.  Passive smoking and cardiorespiratory health in a general population in the west of Scotland. BMJ . 1990;;299:423-427.
12 +
Humble C, Croft J, Gerber A, et al.  Passive smoking and 20-year cardiovascular disease mortality among nonsmoking wives, Evans County, Georgia. Am J Public Health . 1990;;80:599-601.
13 +
Lee P, Chamberlain J, Alderson M.  Relationship of passive smoking to risk of lung cancer and other smoking-associated diseases. Br J Cancer . 1986;;54:97-105.
14 +
He Y.  Women's passive smoking and coronary heart disease. Chin J Prev Med . 1989;;23:19-22.
15 +
Dobson A, Alexander H, Heller R, et al.  Passive smoking and the risk of heart attack or coronary death. Med J Aust . 1991;;154:793-797.
16 +
Svendsen K, Kuller L, Martin M, et al.  Effects of passive smoking in the Multiple Risk Factor Intervention Trial. Am J Epidemiol . 1987;;126:783-795.
17 +
Garland C, Barrett-Connor E, Suarez L, et al.  Effects of passive smoking on ischemic heart disease mortality of nonsmokers. Am J Epidemiol . 1985;;121:645-649.
18 +
Hirayama T.  Lung cancer in Japan: effects of nutrition and passive smoking.  In: Mizell M, Correa P, eds. Lung Cancer: Causes and Prevention . New York, NY: Verlag Chemie International; 1984;.
19 +
Glantz S, Parmley W.  Passive smoking and heart disease. Circulation . 1991;;83:1-12.
20 +
Surgeon General. The Health Consequences of Smoking: Cardiovascular Disease: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1983;.
21 +
Marchand L, Wilkens L, Hankin J, et al.  Dietary patterns of female nonsmokers with and without exposure to environmental tobacco smoke. Can Causes Control . 1991;;2:11-16.
22 +
Sidney S, Caan B, Friedman G.  Dietary intake of carotene in nonsmokers with and without passive smoking at home. Am J Epidemiol . 1989;;129: 1305-1309.
23 +
Allred E, Bleecker E, Chaitman B, et al.  Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med . 1989;;321:1426-1475.
24 +
Sheps D, Herbst M, Hinderliter A, et al.  Production of arrhythmias by elevated COHb in patients with coronary artery disease. Ann Intern Med . 1990;;113:343-351.
25 +
Stern F, Halperin W, Hornung R.  Heart disease mortality among bridge and tunnel officers exposed to carbon monoxide. Am J Epidemiol . 1988;;128:1276-1288.
26 +
Surgeon General. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Rockville, Md: US Public Health Service, Dept of Health and Human Services; 1990;.
27 +
Feldman J, Shenker I, Etzel R, et al.  Passive smoking alters lipid profiles in adolescents. Pediatrics . 1991;;2:259-264.
28 +
Repace J, Lowery A.  Risk assessment methodologies for passive smoking-induced lung cancer. Risk Anal . 1990;;10:27-37.
29 +
Kleinbaum K, Kupper L, Morganstern H. Epidemiologic Research . San Jose, Calif: Lifetime Learning Publications; 1983;.
30 +
Vainio H, Partanen T.  Population burden of lung cancer due to environmental tobacco smoke. Mutat Res . 1989;;222:137-140.
31 +
Wald N, Nanchahal K, Thompson S, et al.  Does breathing other people's tobacco smoke cause lung cancer? BMJ . 1986;:293:1217-1222.
32 +
Kabat G, Wynder E.  Lung cancer in nonsmokers. Cancer . 1984;;53:1214-1221.
33 +
Humble C, Samet J, Pathak D.  Marriage to a smoker and lung cancer risk. Am J Public Health . 1987;;77:598-602.
34 +
Garfinkel L, Auerbach O, Joubert L.  Involuntary smoking and lung cancer: a case-control study. J Natl Cancer Inst . 1985;;75:463-469.
35 +
Correa P, Pickle L, Fontham E, et al.  Passive smoking and lung cancer. Lancet . 1983;;2:595-597.
36 +
Stellman S, Garfinkel L.  Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women. J Natl Cancer Inst . 1986;;76:1057-1063.
37 +
Rogot E, Murray J.  Smoking and causes of death among US veterans: 16 years of observation. J Natl Cancer Inst . 1980;;95:213-222.
38 +
Beeson W, Mills P, Roland P, et al.  Chronic disease among Seventh-Day Adventists, a low-risk group. Cancer . 1989;;64:570-581.
39 +
Colditz G, Willett A, Stampfer M, et al.  A prospective study of parental history of myocardial infarction and coronary heart disease in women. Am J Epidemiol . 1986;;123:48-58.
40 +
Brackbill R, Frazier T, Shilling S.  Smoking characteristics of US workers, 1978-1980. Am J Ind Med . 1988;;13:5-41.
41 +
Gail M.  Measuring the benefits of reduced exposure to environmental carcinogens. J Chron Dis. 1975;;28:135-147.
42 +
Axelson O.  Aspects on confounding in occupational epidemiology. Scand J Work Environ Health . 1978;;4:85-89.
43 +
Rodericks J, Brett S, Wrenn G.  Significant risk decisions in federal regulatory agencies. Regul Toxicol Pharmacol . 1987;;7:307-320.
44 +
Wells A.  An estimate of adult mortality from passive smoking. Environ Int . 1988;;14:249-265.

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