Objectively measured secondhand smoke exposure and risk of cardiovascular disease
Increased risk of CVD death from secondhand smoke exposure is, in part, explained by an inflammatory process that has been described with exposure to SHS...
Title: Objectively measured secondhand smoke exposure and risk of cardiovascular disease
Authors: M Hamer, E Stamatakis, M Kivimaki, G Lowe, D Batty
Reference: J Am Coll Cardiol 2010; 56:18-23
http://content.onlinejacc.org/cgi/content/short/56/1/18
Reviewer: Joaquin Barnoya, MD, MPH, Contributing Editor, ProCor; Research Assistant, Professor of Surgery, Washington University in St. Louis, Missouri, USA; Director, Research and Education, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala
Reviewer comments: There are two results worth highlighting in this study. First, it confirms (using cotinine levels) what other ecological and epidemiological studies have found: increase risk of CVD death with secondhand smoke (SHS) exposure. Second, this increase risk is in part explained by an inflammatory process that has been described with exposure to SHS. However, there remain other factors to be analyzed to completely understand the pathophysiology of SHS and CVD.
We welcome your comments.
Purpose of study: To determine the association between objectively measured SHS and incident CVD death and to which extent this association could be explained through C-reactive protein (CRP) and fibrinogen.
Location of study: United Kingdom
Study design: This study used data from the Health Survey for England and Scottish Health Survey. These two are annual, ongoing, cross-sectional, population-based surveys of individuals living in households in these two countries. Exposure to SHS was assessed with salivary cotinine. Exposure to SHS was categorized into: low (salivary cotinine less than or equal to 0.05 ng/ml), moderate (0.06 to 0.7 ng/ml), high (0.71 to 14.99 ng/ml), and current smokers (greater than or equal to 15 ng/ml). CVD and all cause mortality were recorded for consenting members. The final sample consisted of 13,443 men and women over age 35 years.
Results: Twenty-nine percent of participants were classified as smokers and 21% had high exposure to SHS. Compared to those with low SHS exposure, smokers and participants with high SHS exposure were younger, more likely to be male, came from lower socioeconomic groups, lived in Scotland, and were less physically active. High SHS was associated with elevated CRP and blood pressure compared with low SHS. Average follow-up was 8.0 years. In never smokers, high SHS exposure was associated with a hazard ratio (HR) of 2.0 (95%CI 1.06, 3.78) for CVD mortality. All cause mortality was also increased, although not significant (HR 1.27, 95%CI 0.89, 1.81). When the biological risk factors (age, sex, CRP, fibrinogen, systolic blood pressure, HDL) where included in the model, the HR for high SHS and CVD death was attenuated by 48% and by 40% for all-cause mortality.
Title: Objectively measured secondhand smoke exposure and risk of cardiovascular disease
Authors: M Hamer, E Stamatakis, M Kivimaki, G Lowe, D Batty
Reference: J Am Coll Cardiol 2010; 56:18-23
http://content.onlinejacc.org/cgi/content/short/56/1/18
Reviewer: Joaquin Barnoya, MD, MPH, Contributing Editor, ProCor; Research Assistant, Professor of Surgery, Washington University in St. Louis, Missouri, USA; Director, Research and Education, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala
Reviewer comments: There are two results worth highlighting in this study. First, it confirms (using cotinine levels) what other ecological and epidemiological studies have found: increase risk of CVD death with secondhand smoke (SHS) exposure. Second, this increase risk is in part explained by an inflammatory process that has been described with exposure to SHS. However, there remain other factors to be analyzed to completely understand the pathophysiology of SHS and CVD.
We welcome your comments.
Purpose of study: To determine the association between objectively measured SHS and incident CVD death and to which extent this association could be explained through C-reactive protein (CRP) and fibrinogen.
Location of study: United Kingdom
Study design: This study used data from the Health Survey for England and Scottish Health Survey. These two are annual, ongoing, cross-sectional, population-based surveys of individuals living in households in these two countries. Exposure to SHS was assessed with salivary cotinine. Exposure to SHS was categorized into: low (salivary cotinine less than or equal to 0.05 ng/ml), moderate (0.06 to 0.7 ng/ml), high (0.71 to 14.99 ng/ml), and current smokers (greater than or equal to 15 ng/ml). CVD and all cause mortality were recorded for consenting members. The final sample consisted of 13,443 men and women over age 35 years.
Results: Twenty-nine percent of participants were classified as smokers and 21% had high exposure to SHS. Compared to those with low SHS exposure, smokers and participants with high SHS exposure were younger, more likely to be male, came from lower socioeconomic groups, lived in Scotland, and were less physically active. High SHS was associated with elevated CRP and blood pressure compared with low SHS. Average follow-up was 8.0 years. In never smokers, high SHS exposure was associated with a hazard ratio (HR) of 2.0 (95%CI 1.06, 3.78) for CVD mortality. All cause mortality was also increased, although not significant (HR 1.27, 95%CI 0.89, 1.81). When the biological risk factors (age, sex, CRP, fibrinogen, systolic blood pressure, HDL) where included in the model, the HR for high SHS and CVD death was attenuated by 48% and by 40% for all-cause mortality.
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