|
|
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 1.008092 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 smoker1538 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+
|
- 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
- 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
- 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 |
26/9315/40
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 |
9/3816/25
|
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 NANA NA
17 4.3
17 5.4 |
48 1.0
44 1.5
21 2.5
NA NANA 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 NANA 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
³ 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
³ 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
³ 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 %) (µm/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 ³ 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 ³ 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
- 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.
|
