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Passive Smoke Exposure and Risk of Death From Coronary Heart DiseasePassive Smoke Exposure and Risk of Death From Coronary Heart Disease

JAMA. 2003;290(13):1708-1709. doi:10.1001/jama.290.13.1708-a
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AUTHOR INFORMATION

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

PASSIVE SMOKE EXPOSURE AND RISK OF DEATH FROM CORONARY HEART DISEASE

To the Editor: From the results of their systematic review, Dr Critchley and colleagues1 estimated that individuals who quit smoking have a 30% reduction in their risk of death from coronary heart disease (CHD). None of the 20 studies in this analysis, however, reported data regarding exposure to secondhand smoke (SHS). This has been a consistent flaw in most published studies on the health risk of smoking.2 In healthy nonsmokers, exposure to SHS causes acute adverse changes in coronary circulation and increases the risk of CHD mortality by about 30%.3 While there has been a 70% decrease in exposure of persons to SHS since 1988-1991, about half of US nonsmoking adults continue to be exposed chronically to SHS,4 and thus it is likely that many nonsmokers in these studies were exposed to SHS. This could result in misclassification errors because some individuals categorized as quitters may continue to be exposed to tobacco smoke. Thus, Critchley et al may have underestimated the risk of mortality between smokers and quitters.

References
Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.  JAMA.2003;290:86-97.
PubMed
Jay SJ. Tobacco blindness.  Tob Control.1997;6:226-227.
PubMed
California Environmental Protection Agency, Office of Environmental Health Hazard Assessment.  Health Effects of Exposure to Environmental Tobacco Smoke, Final ReportSacramento: California Environmental Protection Agency; September 1997.
National Center for Environmental Health, Centers for Disease Control and Prevention.  Second National Report on Human Exposure to Environmental ChemicalsAtlanta, Ga: Centers for Disease Control and Prevention; January 2003. Publication No. 03-0022. Available at: http://www.cdc.gov/exposurereport/. Accessibility verified September 2, 2003.

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Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.  JAMA.2003;290:86-97.
PubMed
Jay SJ. Tobacco blindness.  Tob Control.1997;6:226-227.
PubMed
California Environmental Protection Agency, Office of Environmental Health Hazard Assessment.  Health Effects of Exposure to Environmental Tobacco Smoke, Final ReportSacramento: California Environmental Protection Agency; September 1997.
National Center for Environmental Health, Centers for Disease Control and Prevention.  Second National Report on Human Exposure to Environmental ChemicalsAtlanta, Ga: Centers for Disease Control and Prevention; January 2003. Publication No. 03-0022. Available at: http://www.cdc.gov/exposurereport/. Accessibility verified September 2, 2003.
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