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Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence
Specific Questions to the Committee
The Centers for Disease Control and Prevention requested that the IOM convenean expert committee to assess the state of the science on the relationship between secondhand smoke exposure and acute coronary events. Specifically, the committee was to review available scientific literature on secondhand smoke exposure (including short-term exposure) and acute coronary events, and produce a report characterizing the state of the science on the topic, with emphasis on the evidence for causality and knowledge gaps that future research should address.
In conducting its work the committee was to address the following questions:
What is the current scientific consensus on the relationship between exposure to secondhand smoke and cardiovascular disease? What is the pathophysiology? What is the strength of the relationship?
Is there sufficient evidence to support the plausibility of a causal relation between secondhand smoke exposure and acute coronary events such as acute myocardial infarction and unstable angina? If yes, what is the pathophysiology? And what is the strength of the relationship?
Is it biologically plausible that a relatively brief (e.g., under 1 hour) secondhand smoke exposure incident could precipitate an acute
for exposure data, and for data on pathophysiologic effects of secondhand smoke that could underlie any acute coronary events that might be seen. The literature searches identified thousands of publications relevant to secondhand-smoke pathophysiology and health effects and relevant to smoking bans, from which the committee identified studies to be discussed in this report.
The committee focused on the pathophysiologic, exposure, and epidemiologic studies that it thought most pertinent to its charge, including studies that looked at the cardiotoxic components of secondhand smoke (such as particulate matter). The committee evaluated in great detail 11 publications that specifically assessed the effect of smoking bans on the incidence of acute coronary events (see Chapter 5). Those publications looked at the effects of eight smoking bans in different locations: three publications on overlapping regions of Italy after implementation of a national smoking ban (Barone-Adesi et al., 2006; Cesaroni et al., 2008; Vasselli et al., 2008);