Environmental tobacco smoke exposure and heart disease: A systematic review

Table 6 Relative risk of heart disease among never smokers in relation to four other indices of environmental tobacco smoke exposure

Study No.	Ref.1	Sex	Exposure index2	Relative risk (95%CI)3	Exposure description
3	Lee et al[31]	M	Workplace	0.66 (0.26-1.66)
		F	Workplace	0.69 (0.26-1.87)
		M	Total	0.39 (0.17-0.90)	Home, work, travel, leisure
		F	Total	0.52 (0.24-1.09)	Home, work, travel, leisure
5	Svendsen et al[33]	M	Workplace	1.40 (0.80-2.50)
		M	Total	1.17 (0.62-1.19)	Spouse, work
9	Jackson et al[37]	M	Workplace	1.80 (0.94-3.46)
		F	Workplace	1.55 (0.48-5.03)
		M	Total	1.14 (0.76-1.70)	Home, work
		F	Total	1.56 (0.76-3.20)	Home, work
12	Dobson et al[40]	M	Workplace	0.95 (0.51-1.78)
		F	Workplace	0.66 (0.17-2.62)
		M	Total	1.09 (0.72-1.63)	Home, work
		F	Total	2.24 (1.28-3.91)	Home, work
18	Muscat et al[44]	M	Workplace	1.20 (0.60-2.20)
		F	Workplace	1.00 (0.40-2.50)
		M	Childhood	0.79 (0.39-1.63)	Mother, father, other relatives
		F	Childhood	0.72 (0.30-1.72)	Mother, father, other relatives
19	Tunstall-Pedoe et al[45]	M + F	Total	1.34 (1.07-1.67)	Exposure to tobacco smoke from someone else in the previous three days
		M + F	Biomarker	1.13 (0.93-1.38)	Serum cotinine
20	Steenland et al[46]	M	Workplace	1.03 (0.89-1.19)
		F	Workplace	1.06 (0.84-1.34)
22	Kawachi et al[48]	F	Workplace	1.68 (0.81-3.47)
		F	Total	1.71 (1.03-2.84)	Home, work
24	McElduff et al[50]	M	Total	0.82 (0.55-1.22)	Daily at home, work
		F	Total	2.15 (1.18-3.92)	Daily at home, work
26	He et al[52]	F	Workplace	1.85 (0.86-4.00)4
		F	Total	2.87 (1.36-6.05)	Spouse, work
27	Iribarren et al[53]	M	Total	1.07 (0.96-1.19)	Home, small spaces, large indoor areas
		F	Total	1.10 (1.01-1.20)	Home, small spaces, large indoor areas
28	Rosenlund et al[54]	M	Workplace	1.14 (0.78-1.67)
		F	Workplace	0.94 (0.59-1.50)
		M + F	Total	1.18 (0.87-1.60)	Spouse, work
29	Pitsavos et al[55]	M + F	Workplace	1.97 (1.16-3.34)
		M	Total	1.33 (0.94-1.88)	Home, work
		F	Total	1.39 (0.87-2.23)	Home, work
31	Chen et al[56]	M + F	Workplace	1.70 (0.90-3.20)
		M + F	Total	1.50 (1.03-2.20)	Other people’s tobacco smoke in the previous three days
		M + F	Biomarker	0.86 (0.64-1.16)	Serum cotinine
32	Nishtar et al[57]	M + F	Total	2.87 (1.28-6.42)	Unspecified, but includes spouse and others
33	Whincup et al[58]	M	Biomarker	1.67 (1.03-2.72)	Serum cotinine
36	Hedblad et al[61]	M	Biomarker	2.22 (1.21-4.09)	Blood carboxyhaemoglobin
37	Stranges et al[62]	M	Workplace	0.97 (0.64-1.48)
		F	Workplace	0.96 (0.60-1.55)
		M	Childhood	1.04 (0.72-1.52)	Unspecified
		F	Childhood	0.93 (0.57-1.51)	Unspecified
		M	Total	1.11 (0.69-1.77)	Lifetime; home, work, public places; RR is compared to lower tertile of exposure
		F	Total	0.58 (0.33-1.03)	Lifetime; home, work, public places; RR is compared to lower tertile of exposure
38	Teo et al[63]	M + F	Total	1.37 (1.27-1.48)	Family, friends, co-workers
39	Wen et al[64]	F	Workplace	1.21 (0.74-2.01)5
		F	Childhood	1.49 (1.01-2.22)5	In early life from family members
		F	Total	1.25 (0.69-2.25) 5	Spouse, work, early life
43	He et al[67]	F	Total	1.69 (1.31-2.18)	Home, work
45	Vozoris et al[69]	M + F	Total	1.00 (0.80-1.20)	Exposed on most days in the previous month
47	Gallo et al[71] (EPIC)	M	Workplace	0.93 (0.46-1.90)6
		F	Workplace	0.76 (0.47-1.24)6
		M	Childhood	1.11 (0.72-1.69)6	Parents
		F	Childhood	1.18 (0.88-1.57)6	Parents
48	Hamer et al[72]	M	Biomarker	1.50 (0.85-2.64)	Salivary cotinine
49	Jefferis et al[73]	M + F	Biomarker	0.94 (0.59-1.51)	Serum cotinine
50	Peinemann et al[74]	M + F	Total	1.27 (0.84-1.92)	Home, work, other
51	Chen[75]	M + F	Total	1.16 (0.93-1.45)7	Home, work, other
52	He et al[76]	M	Total	2.24 (0.76-6.59)	Lifetime; home, work
		F	Total	2.10 (0.69-6.33)	Lifetime; home, work
54	Iversen et al[78]	M	Total	0.97 (0.61-1.55)	Time spent in smoke-filled rooms
		F	Total	0.70 (0.44-1.12)	Time spent in smoke-filled rooms
55	Kastorini et al[79]	M + F	Total	4.33 (1.52-12.38)	Partner, parents, children, roommates, colleagues; 30+ min/d
56	Rostron[80]	M + F	Biomarker	1.02 (0.70-1.47)	Serum cotinine
57	Batty et al[81]	M	Biomarker	0.49 (0.19-1.25)	Salivary cotinine
		F	Biomarker	1.26 (0.70-2.24)	Salivary cotinine
58	Shiue[82]	M + F	Total	1.47 (0.96-2.24)	Home, work, other

¹First author of paper;

²Biomarker RRs are all based on cotinine measurement except for study 36 which is based on COHb;

³Relative risks are adjusted for covariates if adjusted data are available. Some of the RRs are repeats of those given in Table 3;

⁴Estimate given by an earlier report of the same study[117];

⁵Results for CVD-Stroke. Results also available for CVD: workplace 0.92 (0.64-1.32), childhood 1.26 (0.94-1.69), total 1.45 (0.95-2.22);

⁶Results for CVD-Stroke. Not available for IHD;

⁷Result for IHD. Result for MI also available: 0.93 (0.66-1.31). M: Male; F: Female; CVD: Cardiovascular disease; IHD: Ischaemic (coronary) heart disease; MI: Myocardial infarction.