The Centers for Disease Control and Prevention (CDC) asked the Institute of Medicine (IOM) to convene an expert committee to assess the state of the science on the relationship between secondhand-smoke exposure and acute coronary events. This report addresses that charge. Specifically, the committee reviewed available scientific literature on secondhand-smoke exposure (including short-term exposure) and acute coronary events, with emphasis on evidence of causality and on knowledge gaps that future research should address. To accomplish its task, the committee was asked to address a series of specific questions, which are presented in Box 1-1.
Inherent in that charge is the evaluation for the following three sets of relationships:
the association between secondhand smoke exposure and cardiovascular disease, focusing on coronary heart disease and not stroke (Question 1);
the association between secondhand smoke exposure and acute coronary events (Questions 2, 3, and 5); and
the association between smoking bans and acute coronary events (Questions 4, 5, 6, 7, and 8).
In response to CDC’s request, IOM convened an 11-member committee to assess the state of the science on the relationship between secondhand-smoke exposure and acute coronary events. The committee included experts in secondhand-smoke exposure, the pharmacology and pathophysiology of secondhand smoke, clinical cardiology, epidemiology (including cardiovascular epidemiology), and statistics. The committee met three times, including two open information-gathering sessions at which the members heard from stakeholders and researchers. The appendix presents the agendas of the public meetings.
The committee also conducted an extensive literature search and reviewed relevant publications. To ensure that it was aware of all relevant studies, the committee searched medical-literature databases from 1997 to the present with keywords that included tobacco smoke pollution, secondhand smoke, passive smoking, smoke-free, smoking bans, and smoking ordinance. The databases searched include EMBASE, MedLine, CRISP, ClinicalTrials.gov, the New York Academy of Sciences GreyLit, NACCHO, and WorldCat. Databases were searched for seasonal changes and long-term trends in acute coronary events before and after smoking-ban legislation,