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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 convene an 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 a cute 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
COMMITTEE’S APPROACH TO ITS CHARGE
In response to CDC’s request, IOM convened an 11-member committee that 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, conducted an extensive literature search, and reviewed relevant publications. The committee reviewed both pathophysiologic and epidemiologic studies, and considered the findings of a 2006 report by the surgeon general of the U.S. Public Health Service, The Health Consequences of Involuntary Exposureto Tobacco Smoke.
Inherent in the committee’s charge was the evaluation of three sets of relationships: