TABLE 1

Sign the Resolution for a Federal Commission on Drug Policy

Contents | Feedback | Search | DRCNet Home Page | Join DRCNet

DRCNet Library | Schaffer Library | Tobacco | 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

1-10 yrs

11 + yrs

Worked with a smoker

1-10 yrs

11 + yrs

Males

Lived with a smoker

1-10 yrs

11 + yrs

Worked with a smoker

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+	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	26/93 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 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 ETS^a No Yes 48.1 48.3 31.5 30.7 164.1 168.7^b 1.51 1.48	Males (n = 10) Exposure to ETS No Yes 75.3 75.9^b 28.3 29.3 158.3 159.8 2.47 2.65^c

^{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
Light^a
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.}}}

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)

			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

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 Light^a 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