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Invited Commentary |

Learning to Act on Secondhand Tobacco Smoke Exposure to Limit Risk for Coronary Heart Disease

R. William Vandivier, MD1
[+] Author Affiliations
1Chronic Obstructive Pulmonary Disease Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora
JAMA Intern Med. 2015;175(1):136. doi:10.1001/jamainternmed.2014.4046.
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Secondhand tobacco smoke (SHS) consists of a combination of mainstream smoke that is exhaled from a smoker and sidestream smoke that is given off by a burning cigarette. There is no known safe level of SHS exposure, and it is associated with multiple health risks including sinorespiratory disease, cancer, and cardiovascular disease. In children, SHS increases the risk of pneumonia, bronchitis, severe asthma, and sudden infant death syndrome, and in adults SHS increases the risk of chronic obstructive pulmonary disease and sinus disease. Multiple national and international agencies have classified SHS as a human carcinogen because it increases the likelihood for individuals to develop cancers of the lung, breast, sinus, head, and neck. Secondhand tobacco smoke also increases the incidence of acute coronary events, a finding that is underscored by the observation that implementation of smoking bans in public places has been associated with decreased hospitalization for acute coronary events. Nonsmokers hospitalized with an acute coronary syndrome appear to be particularly vulnerable to SHS exposure because they have higher rates for 30-day mortality, reinfarction, and hospital readmission.1,2 This is not just a matter of academic interest because reports suggest that as many as 29% of the patients seen by the cardiology service during an inpatient admission3 and 40% of the general hospitalized population4 have detectable evidence of SHS exposure.

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