We were initially surprised by the study completed by Stranges and colleagues1 showing no significant increase in acute myocardial infarction (AMI) related to lifetime secondhand smoke (SHS) exposure. The authors reported a nonsignificant increase in the odds ratio (OR) for AMI when comparing the lowest with the highest SHS exposure tertiles (OR, 1.19; 95% confidence interval, 0.78-1.82). A crude OR between these 2 groups, however, demonstrates more than a doubling of AMI risk (approximately 2.20). We suggest that the relatively small sample size and the low inclusion percentage (67% of total population reduced to 19% never smokers), along with the variability of self-reported exposure data spanning over 35 years, make a nonsignificant result no longer surprising. As the authors acknowledged, an OR of 1.19 is also quantitatively identical to previous epidemiologic assessments of the risk of AMI associated with SHS exposure.2
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