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Tobacco
Health Effects of Exposure to
Environmental Tobacco Smoke

Table 8.1


Cohort Studies on ETS Exposure and Heart Disease

 


Geographical Area
(Reference)

Cohort - Years
of Follow-up; # of Deaths Due to
Heart Disease


Exposure to ETS

 

Results

Relative
Person Risks
Years CHD deaths (95% CI)


Comments

Loma Linda, California
(Butler, 1988)
Spouse Pair Cohort

9785 nonsmoking Seventh-Day Adventists

followed between 1976-1982

87 CHD deaths in nonsmoking women

 

AHSMOG Cohort

 

2345 males and 4122 females of whom 1489 males and 3488 never smoked


followed between
1976-1982


70 females deaths and
76 male deaths from CHD in never smokers

 

Spouse Pair Cohort

Husbands smoking
Never
Past
Current

 

AHSMOG Cohort

 

Females

Lived with a smoker

0

1-10 yrs

11 + yrs

 

Worked with a smoker

0

1-10 yrs

11 + yrs

 

Males

Lived with a smoker

0

1-10 yrs

11 + yrs

 

Worked with a smoker

0

1-10 yrs

11 + yrs

 




43053 60 1.00

8092 16 0.96 (0.6-1.7)

2487 4 1.40 (0.5-3.8)

 

 

 

 

 

12826 33 1.00

3301 9 1.46 (0.7-3.1)

8215 28 1.53 (0.9-2.5)

 

 

13870 44 1.0

5802 13 1.85 (1.0-3.4)

4670 13 1.86 (1.0-3.5)

 

 

 

8725 62 1.00

1729 3 0.41 (0.1-1.3)

3126 10 0.61 (0.3-1.2)

 

 

7999 53 1.00

3160 13 1.26 (0.7-2.3)

2420 9 0.76 (0.4-1.6)

Spouse Pair Cohort

 

RRs adjusted age.

 

AHSMOG Cohort

RRs adjusted for age

 

 

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Results

Population #Events Relative Risk
at Risk: (CHD) (95% CI)


Comments

Japan
(Hirayama, 1984)
91,540 nonsmoking women.

study conducted in 1966-1981

subjects followed for 16 years

494 coronary heart disease (CHD) deaths
Husband’s smoking habits:

nonsmoker


exsmoker or smoked
1-19 cig/day
20+ cig/day




21895 118 1.0


44184 240 1.0 (0.9-1.3)
25461 136 1.3 (1.1-1.6)

RRs adjusted for husband's age and occupation.
San Diego
(Garland, et al., 1985)
695 currently married nonsmoking women.

study conducted in 1972-74

subjects followed for 10 years

19 CHD deaths
Husband’s smoking
habits:

never smoker
exsmoker
current smoker




203 2 1.0
395 15 3.0
a
97 2 2.3

RRs adjusted for age only.

The RR adjusted for age, systolic blood pressure, total plasma cholesterol, obesity, and years of marriage was 2.7 for husbands who were ex- or current smokers compared to husbands whod did not smoke.

 

a 95% confidence interval is not available.

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Results

Population #Events Relative Risk
at Risk: (CHD) (95% CI)


Comments

18 Cities in the U.S.
(Svendsen, 1987)
1245 never smoking married men

study conducted in 1973


subjects followed for 7 years till 1982

endpoints included CHD, fatal and nonfatal events

Wives smoking habits:
never smoker
smoker


never smoker
smoker


coworkers smoked
No
Yes


coworkers smoked
No
Yes

(CHD deaths)
959 8 1.0
286 5 2.23 (0.7-6.9)

(Fatal and nonfatal CHD)
959 48 1.0
286 21 1.61 (1.0-2.7)

(For CHD deaths)

na na 1.0
na na 2.6 (0.5-12.7)

(Fatal and nonfatal CHD)

na na 1.0
na na 1.4 (0.8-2.5)
RRs presented are adjusted for age, baseline blood pressure, cholesterol, weight, drinks/wk and education.


RRs on coworkers' smoking were adjusted for age and wives' smoking status.

 

 

Table 8.1 (Continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Results

Population #Events Relative Risk
at Risk: (CHD) (95% CI)


Comments

Washington County, Maryland
(Helsing, 1988)
3,454 white men and 12,348 white women never smoked

study conducted in 1963

 

 

subjects followed through mid-1975

 


370 CHD deaths in men and 988 CHD deaths in women.

Household passive smoking score

Males:
0
1+
1-5
6-12

Females:
0
1+
1-5
6-12

 

 

 


2434 248 1.0
1020 122 1.31 (1.1-1.6)
459 56 1.38 (1.1-1.8)
561 66 1.25 (1.0-1.6)



4259 437 1.0
8086 551 1.24 (1.1 1.4)
3412 252 1.20 (1.0-1.4)
4674 299 1.27 (1.1-1.5)

RR adjusted for age, housing quality, schooling, marital status.

 

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)

Cohort - Years
of Follow-up; # of Deaths Due to
Heart Disease


Exposure to ETS


Results

Population # Events Relative Risks

at risk: (95% CI)

 


Comments

Western Scotland
(Hole, 1989)
15,399 residents aged 45-64, completed self-administered questionnaire between 1972-1976

followed for an average of 11.5 years

917 never smoker

1538 passive smokers

endpoints: heart disease symptoms including angina, and ischemic heart disease (IHD) death




Males and females
never smoker
passive smoker




Males and females
never smoker
passive smoker

 

 


Angina
917 43 1.00
1538 74 1.11 (0.7, 1.7)

 


IHD deaths
917 30 1.00
1538 54 2.01 (1.2, 3.4)


RRs adjusted for age, sex, social class, diastolic blood pressure, serum cholesterol body mass index.

 

 

Table 8.1 (Continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)

Cohort - Years
of Follow-up; # of Deaths Due to
Heart Disease


Exposure to ETS


Results

Population # Events Relative Risks

at risk (CVD deaths) (95% CI)


Comments

Evans County, Georgia
(Humble, 1990)
1127 women, 943 were nonsmokers, 513 were married to never or current smokers


study conducted in 1960-61

subjects followed for 20 years

 

endpoints included cardiovascular disease death (CVD), smoking related CVD, and all causes

Husband smoker vs. nonsmoker

All subjects
Blacks
Whites (by social
class)
high
low
 

 


513 76 1.59 (1.0, 2.6)
185 na 1.78 (0.9, 3.7)


161 na 1.97 (0.7, 5.3)
167 na 0.79 (0.3, 2.0)

Women whose husbands were exsmokers were excluded.

Baseline comparison group was women whose husbands never smoked.

RRs adjusted for age, blood pressure, cholesterol, and body mass index.

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Males

OR 95% CI

Females

OR 95% CI


Comments

United States
(Le Vois and Layard, 1995)

CPS-I

Total of 88,458 male and 247,412 female never smokers

 

CHD deaths:
7768 in males
7133 in females

 

 

CPS-II

108,772 male and 226,067 female never smokers; smoking status of spouses was known

 

CHD deaths:
1966 in males
1099 in females

 

Exposed to:

Any smoking spouse

Former smoker

 

#cigarettes/day

1-19

20-39

40+

 

 

Exposed to:
Any smoking spouse

Former smoker

 

#cigarettes/day

1-19

20-39

40+

 

 

 

  1. 0.90-1.05

0.95 0.83-1.09

 

 

0.99 0.89-1.09

0.98 0.85-1.18

0.96 0.78-1.15

 

 

 

  1. 0.87-1.08

0.81 0.70-0.98

 

 

1.36 1.10-1.68

1.28 1.00-1.58

1.13 0.81-2.11

 

 

 

 

1.08? 0.98-1.08

0.99 0.93-1.06

 

 

1.04 0.97-1.12

1.06 0.98-1.16

0.96 0.78-1.15

 

 

 

1.00 0.88-1.14

0.99 0.86-1.13

 

 

1.14 0.86-1.51

0.98 0.75-1.29

1.27 0.80-2.01

 

 

 

ORs presented were adjusted for age and race. Further adjustment for weight, exercise, education, dietary factors, history of hypertension and diabetes did not have any appreciable effect on risks. These ORs were not presented.

 

 

Follow-up period during which these CHD deaths were observed was not described.

 

OR’s were adjusted for age and race.

 

 

-------------------------------

These analyses utilize the same datasets analyzed by Steenland et al. (1996)
(see next page).

 

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Males

OR 95% CI

Females

OR 95% CI


Comments

United States
(Steenland et al., 1996)

 

 

Analysis 1

Spousal cohort of 101,227 male and 208,372 female never smokers

 

CHD deaths:

2494 men

1325 women

 

 

Analysis 2

Spousal subcohort with single marriage and data on amount and duration of exposure to smoking during marriage

 

58,530 male and 99,821 female never smokers

 

CHD deaths:

1299 men

572 women

Exposed to:

Current smoker

cigarettes/day

<20

20

21-39

40+

 

Former smoker

 

 

 

Exposed to:

Current smoker

Former smoker

Years exposed to cigarette smoke

1-12

13-21

22-29

30+

 

 

 

 

 

 

 

1.22 1.07-1.40

 

1.33 1.09-1.61

1.17 0.92-1.48

1.09* 0.77-1.63

 

 

  1. 0.83-1.11

 

 

 

 

1.48 1.21-1.80

0.97 0.79-1.20

 

 

1.14 0.80-1.63

1.13 0.80-1.69

1.14 0.84-1.56

1.25 1.01-1.53

 

 

 

 

 

 

 

1.10 0.96-1.27

 

1.15 0.90-1.45

1.07 0.90-1.28

0.99 0.87-1.47

1.04 0.88-1.13

 

1.00 0.88-1.13

 

 

 

 

1.18 0.91-1.46

1.08 0.90-1.29

 

 

0.84 0.59-1.20

0.99 0.73-1.39

1.20 0.91-1.59

1.20 0.96-1.46

 

 

 

 

 

These ORs were adjusted for age, self-reported history of heart disease, hypertension, diabetes, arthritis, body mass index, educational level, aspirin use, diuretic use, liquor consumption (in men), wine intake (in women), employment status, exercise, and estrogen use (in women).

 

 

 

 

 

 

 

 

 

 

 

-----------------------------------

These analyses utilize the same datasets analyzed by LeVois and Layard (1995) (see preceding page).

* For those whose spouses smoke >21 cigarettes per day

 

Table 8.1 (continued)
Cohort Studies on ETS Exposure and Heart Disease

 


Geographical Area
(Reference)


Cohort Description


Exposure to ETS

Males

OR 95% CI

Females

OR 95% CI


Comments

United States
(Steenland et al., 1996)

 

 

Analysis 3

Subjects concordant for both self-reported current exposure to cigarettes and exposure based on spouse report

 

54,668 male and 80,549 female never smokers[?]

 

CHD deaths:

1180 men

426 women

 

Analysis 4

Restricted to those currently employed

 

76,710 male and 75,237 female never smokers

 

CHD deaths:

1751 men

768 women

 

Exposed currently

Self-report:

1-2 hours/day

3-4 hours/day

>4 hours/day

 

Smoking reported
by spouse:

cigarettes/day

<20

20

21-39

40+

 

 

 

 

Exposed at home

Exposed at work

Exposed elsewhere

 

 

 

1.23 1.03-1.47

 

1.23 0.81-1.07

1.35 0.95-1.90

1.13 0.84-1.61

 

 

 

 

1.37 1.04-1.79

1.15 0.86-1.53

1.12* 0.77-1.83

 

 

 

 

 

1.15 1.01-1.32

1.03 0.89-1.19

1.03 0.93-1.13

 

 

1.19 0.97-1.45

 

0.70 0.45-1.10

1.21 0.85-1.74

1.28 1.10-1.62

 

 

 

 

1.22 0.88-1.72

1.14 0.83-1.67

1.02 0.66-1.60

1.28 0.81-2.01

 

 

 

 

1.07 0.96-1.17

1.06 0.84-1.34

0.91 0.83-1.00

 

In analysis 4, the number of subjects in the cohort and the number of CHD deaths applied to the analysis for exposure at work. The numbers varied somewhat for the analyses on exposure at home and elsewhere.

* For those whose spouses smoke >21 cigarettes per day

Table 8.2
Case Control Studies on ETS Exposure and Heart Disease

 

 

 

Geographical Area
(Reference)

Subjects
(cases, controls)
control type

 

Exposure to ETS

 

Cases/Controls

 

OR (95% CI)

 

 

Comments

United Kingdom
(Lee, 1986)
- 507 males and females with IHD

- hospital controls

- a subset of cases and controls responded to questions on passive smoking
Nonsmoking men exposed to spouse

No
Yes

Nonsmoking women exposed to spouse

No
Yes

Nonsmoking men exposed to combined sources:
score 0-1
2-4
5-12
Nonsmoking women exposed to combined sources:
score 0-1
2-4
5-12



26/93

15/40





22/89

55/229





15/27

12/55

3/15




23/75

9/61

4/21

 

 

 

 

1.00
1.24 (0.6-2.8)

 

 

 

1.00
0.93 (0.6-1.7)

 

 

 

1.0
0.43(0.2-0.9)
0.43(0.1-1.4)

 

 

1.0
0.59 (0.2-1.1)
0.81 (0.2-2.0)

 

 

Reason for varying sample sizes in analysis was not provided.

Combined index of exposure at home, work, during travel and leisure. A score of 0 to 3 is assigned separately to exposure at home, work, during travel, and leisure, for a maximum score of 12. Scores of 0 = not all; 1= little; 2 = average;
3 = a lot.

 

The confidence intervals were calculated based on the distribution of cases and controls presented in references.

 

 

Table 8.2 (Continued)
Case Control Studies on ETS Exposure and Heart Disease

 

 

 

Geographical Area
(Reference)

Subjects
(cases, controls)
control type

 

Exposure to ETS

 

Cases/Controls

 

OR (95% CI)

 

 

Comments

Newsouth Wales, Australia
(Dobson, 1991)
- Subjects with myocardial infarction (MI) or coronary death, age 35-69, between July 1988-October 1989

- Controls selected from a community based risk-factor survey

- Cases interviewed by nurses while in hospital, controls completed self-administered questionnaire
Nonsmoking men
Not exposed at home
Exposed at home

Not exposed at work
Exposed at work

Nonsmoking women
Not exposed at home
Exposed at home

Not exposed at work
Exposed at work

161/259 22/34

48/126

27/79


117/433

43/99


5/73

12/124

 

 

 

1.00
0.97 (0.50, 1.86)

 

1.00
0.95 (0.51, 1.78)

 

 

1.00
2.46 (1.47, 4.13)

1.00
0.66 (0.17, 2.62)

 

ORs adjusted for age, and history of MI

Only subset with information on exposure at work.

Data on passive smoke at work available on only a subset, reasons for missing data not explained.
People's Republic of China
(He et al., 1989)
- 34 women CHD (12 MI, 22 diagnosed by coronary arteriography)

- 68 controls
(34 population, 34 hospital control)
Nonsmoking women
Husband smoked
Yes
No


9/38

16/25

 

 

 

1.0
3.0 (1.3-7.2)

 

 

The OR was adjusted for personal and family history of hypertension, family history of CHD, drinking, physical exercise and history of hyperlipidemia.

 

 

Table 8.2 (Continued)
Case Control Studies on ETS Exposure and Heart Disease

 

 

 

Geographical Area
(Reference)

Subjects
(cases, controls)
control type

 

Exposure to ETS

 

Cases/Controls

 

OR (95% CI)

 

 

Comments

Italy
(La Vecchia et al., 1993)

 

- Acute MI patients

113 cases
(44 females, 69 males)

 

- Controls admitted to same hospitals for acute conditions not related to CHD

 

Spousal smoking habits

never smoker

former smoker

current smoker

<15 cigarettes/d

15+ cigarettes/d

Males Females

case/con case/con

55/140 11/17

2/4 15/19 7/17 17/20

5/11 6/8

2/6 11/12

 

 

1.0

0.91 (0.4-2.3)

1.21 (0.6-2.5)

1.13 (0.5-2.8)

1.30 (0.5-3.4)

OR obtained from multiple regression; adjusted for sex, age, education, coffee intake, body mass index, serum cholesterol, hypertension, diabetes and family history of MI.
People’s Republic of China
(He et al., 1994)

 

- Non-fatal CHD female cases in lifelong nonsmokers; identified from the 3 large teaching hospitals in Xian between 1989 and 1992;

 

- Controls were from three sources and were combined in all analyses because they did not display significant differences by various characteristics

Passive smoking from

husband work

no no

yes no

no yes

yes yes

 

 

Passive smoking
at work

Number of smokers

0

1-2

3

4+

Test for trend

 

 

cases controls

11 50

15 33

10 18

23 25

 

 

 

 

cases controls

26 83

16 36

12 6

5 1

 

 

 

 

1.0

2.07 (0.8-5.6)

2.42 (0.8-7.8)

4.18 (1.6-10.9)

 

 

 

 

 

1.00

1.16 (0.5-2.8)

5.06 (1.4-18.0)

4.11 (0.4-43.7)

 

 

Crude ORs are shown.

 

 

 

 

 

 

 

 

OR is adjusted for age, history of hypertension, personality type, total cholesterol, and passive smoking from

husband.

 

Table 8.2 (Continued)
Case Control Studies on ETS Exposure and Heart Disease

 

 

Geographical Area
(Reference)

Subjects
(cases, controls)
control type

 

Exposure to ETS

 

Cases/Controls

 

OR (95% CI)

 

 

Comments

United States
(Muscat and Wynder, 1995)

 

- Subjects with MI identified in four hospitals in the US between 1980-1990; hospital controls were used.

 

- Cases and controls interviewed while in the hospital.

Adult exposure

 

None

1-20 years

21-30

>30

 

 

None

1-20 years

21-30

>30

 

 

Males

38/68

12/15

5/8

13/17

 

Females

13/20

12/8

5/9

16/13

 

 

1.0

1.7 (0.7-4.5)

1.5 (0.4-5.2)

1.1 (0.4-2.8)

 

 

1.0

2.0 (0.5-8.1)

0.9 (0.2-4.4)

1.7 (0.5-5.9)

 

OR was adjusted for age, education and hypertension.
United States

(Layard, 1995)

 

- Cases and controls were from National Mortality Follow-back Survey conducted in 1986.

Next-of kin completed a self-administered questionnaire

 

Spousal smoking

cigarettes/day

none

1-<15

15-34

35+

 

cigarettes/day

none

1-<15

15-34

35+

 

 

Males

378/783

38/107

45/92 6/12

 

Females

459/969

139/336

224/405

52/111

 

 

 

1.0

0.8 (0.5-1.1)

1.1 (0.7-1.6)

0.9 (0.9-2.6)

 

 

1.0

0.9 (0.7-1.1)

1.2 (0.9-1.4)

1.1 (0.7-1.5)

Causes of death of controls were not specified.

 

ORs were adjusted for age and race; cases were significantly older than controls.

 

Table 8.2 (Continued)
Case Control Studies on ETS Exposure and Heart Disease

 

 

 

Geographical Area
(Reference)

Subjects
(cases, controls)
control type

 

 

Exposure to ETS

 

Cases/Controls

 

OR (95% CI)

 

 

Comments

New Zealand

(Jackson, unpublished)

 

 

 

 

- Cases included acute MI patients and fatal CHD patients

 

- Self-respondent population controls and next-of-kin of controls were compared to directly interviewed cases and next-of-kin of fatal CHD patients

Questions on ETS were added to an ongoing case-control study conducted in New Zealand.

 

Males: 28 acute MI cases compared to 123 controls;
21 fatal CHD cases compared to 61 controls

 

Females: 11 acute MI cases compared to 112 controls;
9 fatal CHD cases compared to 62 controls

 

Acute MI:

M 1.0 (0.3-4.3)

F 2.7 (0.6-13.6)

 

Fatal CHD:

M 1.1 (0.2-4.5)

F 5.8 (1.3-48.0)

ORs were adjusted for age and social class.

 

The baseline comparison had no ETS exposure at home.

 

Abbreviations: MI = myocardial infarction; CHD = coronary heart disease

TABLE 8.3
RISKS OF HEART DISEASE AND ACTIVE SMOKING IN WOMEN

 

Cohort Study Smoking Status Person-Years Fatal
CHD RR
# Event
Nonfatal MI
#Event RR
Fatal CHD & Nonfatal MI
#Event RR
Angina
# Event RR
Comments
Willett, 1987 Nonsmoker
Exsmoker
Current
(cig/day)
1-14
1-4
5-14
15-24
25+
302,375
174,237


61,400
15,765
45,635
95,430
63,359
15 1.0
11 1.2


5 1.9
NA NA

NA NA

17 4.3
17 5.4

48 1.0
44 1.5


21 2.5
NA NA

NA NA
65 4.7
64 6.3

63 1.0
55 1.5


26 2.3
7 2.4
19 2.1
82 4.7
81 6.1
31 1.0
30 1.6


11 1.8
NA NA

NA NA
19 1.5
17 2.3

U.S. cohort study of 119,404 nurses, aged 30-55, followed between 1976 to 1982.

 

 

Case-control Studies Smoking
Status
CA/CO RR CA/CO RR   Comments
Beard, 1989 Smoker
Yes
No

17/70
69/80
For CHD
1.0
5.11*

44/117
84/115
For Angina
1.0
2.77*
  CHD includes MI and
sudden unexpected deaths.

Subjects aged 40-59.

Palmer, 1989 Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
1-4
5-14
15-24
25-34
35-44
45
any tobacco

191/940
149/550


11/36
54/140
213/412
110/136
120/129
58/21
570/885
For MI
1.0
1.4 (1.0-1.8)


2.4 (1.1-5.1)
2.5 (1.7-3.6)
3.0 (2.3-3.8)
5.1 (3.6-7.1)
4.9 (3.5-6.8)
22 (12-39)
3.7 (3.0-4.7)
      Multi-centered hospital
-based cases and controls.

Cases between ages 25-64.

 

TABLE 8.3 (Continued)
RISKS OF HEART DISEASE AND ACTIVE SMOKING IN WOMEN

 

Case-control Studies Smoking Status CA/CO RR for CHD       Comments
Gramenzi, 1989 Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
1-14
15-24
25+

90/346
10/16


57/91
65/48
40/18
For MI
1.0
1.5 (0.6-3.6)


2.3 (1.4-3.7)
5.9 (3.2-9.3)
11.0 (5.1-23.7)
     

 

Hospital-based study in Northern Italy, subjects aged 22-69.
Rosenberg, 1985 Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
1-14
15-24
25-34
35+

73/571
35/267


40/211
139/449
96/152
171/190
For MI
1.0
1.0 (0.7-1.6)


1.4 (0.9-2.1)
2.4 (1.8-3.3)
5.0 (3.6-6.9)
7.0 (5.2-9.4)
      Multi-centered US hospital-based study.
Subjects aged 25-49.

NA - not available

 

TABLE 8.4
RISKS OF HEART DISEASE AND ACTIVE SMOKING IN WOMEN BY AGE

 

Case-control Studies Smoke # Event RR # Event RR # Event RR Comments
Willett, 1987 Active Smoking
Nonsmoker
Current
(cig/day)
1-14
15-24
25+
Age 30-39
5 1.0


0 -
6 4.3 (1.3-13.7)
3 3.5 (0.8-14.5)
Age 40-49
20 1.0


7 1.6 (1.1-2.4)
24 3.6 (2.4-5.5)
33 7.0 (4.8-10.5)
Age 50-59
38 1.0


19 2.4 (1.5-3.9)
52 4.1 (2.9-5.9)
45 5.3 (3.7-7.6)
Outcome: Fatal CHD and Nonfatal MI.
Bush and Comstock, 1983 Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
1-9
10-20
21+
Age 25-44
12 1.0
4 1.8


4 1.5
10 3.7
8 2.4
Age 45-64
219 1.0
18 0.7


38 1.1
73 1.4
36 2.2
Age 65-74
355 1.0
13 0.8


20 1.0
17 0.8
1 0.1
Outcome: Total arteriosclerotic heart disease deaths.

RRs adjusted for marital status, education, housing index, and frequency of church attendance.
No information on other risk factors for heart disease.
  Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
1-9
10-20
21+
Age 25-44
5 1.0
4 4.6


1 1.1
8 4.1
6 7.5
Age 45-64
116 1.0
11 0.9


24 1.3
51 1.9
24 2.8
Age 65-74
171 1.0
10 1.2


11 1.1
10 0.3
1 0.4
Outcome: Arteriosclerotic heart disease, sudden.

 

 

TABLE 8.4 (Continued)
RISKS OF HEART DISEASE AND ACTIVE SMOKING IN WOMEN BY AGE

 

Case-control Studies Smoke CA/CO RR CA/CO RR CA/CO RR Comments
Gramenzi, 1989 Active Smoking
Nonsmoker
Exsmoker
Current
(cig/day)
<15
15-24
25
Age <50
na 1.0
na 2.2


na 2.1
na 4.6
na 7.7
Age >50
na 1.0
na 1.0


na 2.7
na 7.3
na na
  Outcome included acute myocardial infarction.

RRs adjusted for age, education, alcohol and coffee intake, diabetes, hypertension, hyperlipidaemia, body mass index, and use of oral contraceptives.
Rosenberg et al., 1985 Active smoking

Nonsmoker
Exsmoker
Current
(cig/day)
1-14
15-24
25-34
35+
Age 25-39

10/117 1.0
5/48 1.2


4/47 1.0
25/101 2.9
23/27 10
41/37 13
Age 40-44

18/156 1.0
4/86 0.4


8/56 1.2
40/154 2.3
28/56 4.3
58/61 8.2
Age 45-49

45/298 1.0
26/133 1.3


28/108 1.7
74/194 2.5
45/69 4.3
72/92 5.2
Outcome included myocardial infarction.

Unadjusted RRs.

 

TABLE 8.5
EFFECT OF EXPOSURE TO ETS ON EXERCISE TOLERANCE

 

Study

Study Subjects/Test

Parameter    
Aronow (1978) 10 men with stable angina
exposed to 3 smokers who each smoked cigarettes over 2 hours
subjects exercised on bicycle ergometer until onset of angina



Duration of exercise in seconds (SD)

Plasma
Carboxyhemoglobin (%)

In Well-Ventilated Room
Exposure to ETS

No Yes

232.3 68.4 181.1 52.4a


1.25 0.20 1.77 0.16a

In Unventilated Room
Exposure to ETS

No Yes

233.7 64.8 145.8 36.9a


1.30 0.18 2.28 0.15a

Leone (1991) 19 nonsmoking males, 9 healthy and 10 with history of MI
exposed in an enclosed space with 30-35 ppm CO (with combustion of 15-20 cigarettes within 30 minutes)
subjects underwent exercise stress test on a bicycle ergometer twice



Peak exercise
(in seconds SD)

Time to recovery
(m min SD)

Expired CO (ppm)
pre-exercise
post-exercise

Plasma CO (%)
pre-exercise
post-exercise
Healthy Subjects, Exposed to ETS
No Yes

220 30 220 30


8.50 4 19 4b



2.3 2 2.3 2.01
2.1 1.9 8.5 1.6d


1.2 0.4 1.4 0.2
1.2 0.4 1.7 0.4
MI Patients Exposed to ETS
No Yes

120 20 80 25b


12.3 2 21 2.5b



1.2 0.8 0.6 0.2c
1.3 0.6 5.2 1.2d


1.2 0.1 1.2 0.16
1.2 0.3 2.3 0.4d

 

a p <0.001= Comparing exposed to ETS to not exposed under different ventilation conditions

b p <0.01 = Comparing exposed to ETS to not exposed

c p <0.05 = Comparing exposed to ETS to not exposed

d p <0.01 = Comparing post-exercise to pre-exercise level among subjects exposed to ETS

 

 

 

TABLE 8.5 (Continued)
EFFECT OF EXPOSURE TO ETS ON EXERCISE TOLERANCE

 

 

Study

Study Subjects/Test

Results

McMurray (1985) 8 normal women,
4 smokers and 4 non-smokers exposed to pure air and air contaminated with ETS
subjects completed an exercise trial which included running 20 min at about 70% VO2max.

increase treadmill grade by 2-1/2% every 2 min until subject could not continue with exercise





Max 02 uptake (l/min)

Duration of exercise (minutes)

Maximal R value

Lactate(mM)

Ratings of perceived exertion (units)

Ve/V02 (l air/l 02)

Heart rate (beats/min)
Submaximal Exercise
Exposure to ETS
No Yes

1.82 1.85

-- --


0.86 0.91

-- --

11.8 13.8a


27.5 28.4

173 178a
Maximal Exercise
Exposure to ETS
No Yes

2.39 2.13a

25.8 23.6a


0.93 1.01

5.5 6.8a

16.5 17.4a


30.5 33.5a

194 194

 

a p <0.05, comparing exposed to ETS to not exposed under submaximal or maximal exercise.

 

 

 

 

TABLE 8.5 (Continued)
EFFECT OF EXPOSURE TO ETS ON EXERCISE TOLERANCE

 

 

Study

Study Subjects/Test

Results

Pimm (1978) 20 health men and women, ages 18-30
exposed for 2 hours on alternate days to room air or air contaminated with tobacco smoke (about 24 ppm of CO)
subjects performed a 7-minute exercise test on an electronic bicycle ergometer (submaximum bicycle test)




Ventilation (l/min)

Number of breaths per minute

Heart rate (beat/min)

V02 (l/min)
Females (n = 10)
Exposure to ETSa
No Yes

48.1 48.3

31.5 30.7


164.1 168.7b

1.51 1.48
Males (n = 10)
Exposure to ETS
No Yes

75.3 75.9b

28.3 29.3


158.3 159.8

2.47 2.65c

a Values measured at 7 minutes of submaximum bicycle test.

b p<0.01 by paired to test.

c p<0.05 by paired to test.

 

 

 

TABLE 8.6
EFFECT OF EXPOSURE TO ETS ON LIPID PROFILE IN CHILDREN

 

 

Study Study Subjects

Results

Moskowitz (1990) 111 adolescents with both nonsmoking parents

105 adolescents with at least one smoking parent
Exposure Thiocyanate Cotinine Cholesterol LDL HDL HDL2 HDL3 2-3 DPG
to ETS (mg/L) (ng/ml) (mg %) (mg %) (mg %) (mg %) (mg %) (m/ml)


No 3.1 5.0 NDa 172.2 86.1 49.1 13.5 35.6 1.97
Yes 7.1 4.3 1.5 3.1 164.1* 81.3 46.0* 12.5 33.5* 2.09**
Feldman (1991) 274 boys, 117 girls

34% no exposure; 15% mother smoked only; 17% father smoked only; 12% both parents smoked; 22% friends/siblings smoked.
Total Cholesterol/HDL-C Ratios ( SD)
by Serum Cotinine Level
<2.5 ng/ml (n=347)c 2.5 ng/ml (n=44)c
3.51c 3.92
Exposure to ETS
None 3.47 ( 0.87) 3.77 ( 0.76)
Friend/sib only 3.55 ( 0.90) 3.70 ( 1.13)
Mother, not father 3.34 0.55) 4.06 ( 1.00)
Father, not mother 3.64 ( 0.78) 4.22 ( 1.04)
Father & mother 3.68 ( 0.85) 3.91 ( 1.02)

a ND = non-detectable. Data presented are the mean levels of cholesterol, lipoproteins, and 2-3 DPG, adjusted for age, weight, height, and sex.

b The Total-C/HDL-C for the group with cotinine level <2.5 ng/ml was 3.51, and 3.92 for the group with cotinine level 2.5 mg/ml. These values are calculated based on data presented in table (i.e., Table 2 of reference).

 

* p<0.05, ** p<0.001

 

 

TABLE 8.7
PLATELET SENSITIVITY TO ANTIAGGREGATORY PROSTAGLANDINSa BEFORE AND AFTER EXPOSURE TO ETS

 

 

Sinzinger (1982) b
Exposed to passive smoking
Nonsmokers
Smokers
Before


1.26 0.11

1.75 0.26

After

 

2.16 0.21 (p<.01)
2.08 0.19 (NS)

Burghuber (1986) c
Exposed to active smoking d
Nonsmokers
Smokers
Exposed to passive smoking e
Nonsmokers
Smokers


1.61
3.33

1.25
1.89


2.08 (p<.01)
3.13 (NS)

1.82 (p<.01)
2.04 (NS)

 

a Values represent the concentration of protascyclin necessary to inhibit ADP induced platelet aggregation to 50%. Values are in units of PG in ng/ml platelet rich plasma, means serum.

 

b Exposure to passive smoking occurred in a 18m3 room were 30 cigarettes were smoked to give a smoke concentration resembling that in discos or restaurants. Subjects were exposed for 15 minutes. Blood was collected before and at the end of the smoking period, as well as 20 and 60 minutes later.

 

c Values shown are calculated in the following way: Sensitivity index of PGI2 were obtained from extrapolating values in Figures 3 and 4 in reference. From these figures, we estimated that the sensitivity index were 0.62, 0.48, 0.30, 0.32, 0.80, 0.55, 0.53, 0.49 (values are presented in the order under 'Before' and 'After' columns, for each of the 4 rows). Since sensitivity index equals 1/ID50, where ID50 is the concentration of PGI2 necessary to inhibit ADP-induced platelet aggregation to 50 percent, ID50 was calculated is 1/sensitivity index (e.g., 1/0.62=1.61).

 

d Active smoking experiment: Fourteen healthy males smoked two cigarettes within 10 minutes. Blood specimen were collected immediately before and 15 minutes after smoking.

 

e Passive smoking experiment: Twenty-two health males were exposed for 20 minutes in an 18 m2 room in which 30 cigarettes were smoked. Blood specimen was collected immediately before and 15 minutes after passive smoking period.

 

 

TABLE 8.8
MEASURES OF PLATELET FUNCTION IN RELATION TO EXPOSURE TO
ACTIVE SMOKING AND PASSIVE SMOKING

 

     

PLATELET FUNCTION

Study Number of Subjects Exposure Endothelial Cells/
Chamber
Platelet Aggregate Ratios
Davis et al. (1985)



20
20


20
20

Smoked tobacco
Cigarettes
Beforea
After
Smoked non-tobacco
cigarettes
Before
After


2.3 0.5
4.8 1.3


2.5 1.1
3.0 1.1


0.80 0.06
0.65 0.07


0.81 0.10
0.78 0.10
Davis (1989)


10
10

10
10

Control Period
Before
After
Exposed to ETSb
Before
After

2.2 .8
2.3 1.0

2.8 0.9
3.7 1.1

0.88 0.05
0.88 0.04

0.87 0.06
0.78 0.07

 

a All the 'before' and 'after' differences were statistically significant at p<0.01.

b Nonsmokers were exposed to ETS for 20 minutes in open hospital corridors by sitting next to smokers.

Table 8.9

Carotid artery intimal-medial thickness (IMT) as measured by B-mode ultrasound in current smokers, ex-smokers, never smokers

 

Study

 

Number of subjects Exposure Mean IMT wall thickness
(in mm)
Comments
Howard et al. (1994) 3525

 

4315

 

3339

 

1774

 

 

Active smokers

 

Ex-smokers

 

Passive smokers

 

Never smokers not

exposed to ETS

 

 

0.775

 

0.772

 

0.711

 

0.700

 

Crude means are shown.
The difference between passive smokers and never smokers was 0.011 mm. This difference changed to 0.017mm after adjustment for age, race, and gender (P 0.0001) and to 0.014 mm after additional adjustment for lifestyle factors including education, physical activity, alcohol intake, body mass index, and Key’s score (P=0.0009).
 

Diez-Roux et al. (1995)

 

 

Males and females

456

 

448

 

 

259

 

282

77

211

 

 

Current smokers in

  1. 1989

 

Former smokers in

1987-1989 and in 1975

 

ETS in 1975, 1987-89

 

ETS in 1987-89 only

ETS in 1975 only

no ETS

Adjusted means
standard error

 

0.807 0.009

 

 

0.757 0.009

 

0.734 0.012

 

0.738 0.011

0.731 0.022

0.706 0.013

Mean wall thickness was adjusted for gender, age, systolic blood pressure, LDL cholesterol, presence of Key’s score, physical activity scores, alcohol intake and education using multiple linear regression.

 

 

Table 8.10

Endothelium-dependent arterial dilatation
in active smokers, never smokers exposed to ets, and never smokers not exposed

 

Study Number of Subjects Exposure Flow-mediated dilatation
(mean values + SD; in %)

 

Celermajer et al. (1996)

 

26

 

26

 

26

 

 

 

13

13

 

 

13

13

 

 

 

9

9

8

 

Active smokers

 

Never smokers exposed to ETS

 

Never smokers not exposed to ETS

 

By gender

Never smokers exposed to ETS

Males

Females

 

Never smokers not exposed to ETS

Males

Females

 

By level of ETS exposure

Never smokers exposed to ETS

Lighta

Moderate b

Heavy c

 

4.4* 3.1

 

3.1* 2.7

 

8.2 3.1

 

 

 

3.2 2.5

3.0 2.9

 

 

7.3 1.9

9.1 3.9

 

 

4.1 3.3

3.1 2.2

1.8 2.0

 

 

a "Light" is defined as never smokers who were exposed to 1 to 3 hours of ETS at home or at work for at least 3 years

b "Moderate" is defined as never smokers who were exposed to 4 to 6 hours of ETS at home or at work for at least 3 years

c "Heavy" is defined as never smokers who were exposed to > 6 hours of ETS at home or at work for at least 3 years

 

* P value < 0. 05 for never smokers exposed to ETS compared to never smokers not exposed, and
for active smokers compared to never smokers not exposed to ETS.

 

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