Table 8.1

Cohort studies of secondhand smoke exposure and the risk of coronary heart disease (CHD) among nonsmokers

StudyDesign/populationDuration of follow-up (years)ExposureFindingsRelative risk (95% confidence interval)Variables controlled for
Hirayama 1984, 199091,540 women
Aged ≥40 years
16Husband smokedDeath from ischemic heart disease (IHD)1.18 (0.98–1.41)Age
Garland et al. 1985 695 women
Lifetime nonsmokers
Aged 50–79 years
United States (California)
10Husband smoked (self-reported)Death from CHD2.7 (0.59–12.33)Age, systolic blood pressure, serum cholesterol level, body mass index (BMI), years of marriage
Svendsen et al. 1987 1,245 married men
Lifetime nonsmokers
Aged 35–57 years
Free of CHD at baseline but at high risk
Enrolled in the Multiple Risk Factor
Intervention Trial
United States (18 cities)
Average of 7Wife smokedDeath from CHD2.23 (0.72–6.92)Age, blood pressure, serum cholesterol level, body weight, alcohol consumption, level of education
Butler 1988 6,507 Seventh-Day Adventist women married to men also enrolled in the study
Aged ≥25 years
United States (California)
6Husband smokedDeath from CHD1.4 (0.51–3.84)Age
Helsing et al. 1988 (not included in the meta-analysis conducted for this 2006 Surgeon General’s report)3,488 men and 12,348 women
Lifetime nonsmokers
Aged ≥25 years
United States (Western Maryland)
12Cohabitant smokedDeath from CHDMen: 1.31 (1.1–1.6)
Women: 1.24 (1.1–1.4)
Age, education, marital status, housing quality
Hole et al. 1989 671 men and 1,784 women
Lifetime nonsmokers
Aged 45–64 years at baseline
Average of 11.5Cohabitant smokedDeath from IHD2.01 (1.21–3.35)Age, gender, social class, diastolic blood pressure, serum cholesterol level, BMI
Sandler et al. 1989 (not included in 2001 review)4,162 White men and 14,873 White women
Lifetime nonsmokers in 1963
Aged ≥25 years
United States (Maryland)
12Home exposure from any household member who smokedDeath from CHD1.22 (1.09–1.37)Age, marital status, years of schooling, quality of housing
Humble et al. 1990 513 women
Lifetime nonsmokers
Aged 40–74 years
United States (Georgia)
20Husband smoked at baselineDeath from CHD1.59 (0.99–2.57)Age, serum cholesterol level, diastolic blood pressure, BMI, and square of BMI
LeVois and Layard 1995 (not included in the meta-analysis conducted for this 2006 Surgeon General’s report)88,458 men and 247,412 women
Lifetime nonsmokers
CPS-I* data
United States
13Spouse smokedDeath from CHD1.0 (0.97–1.04)Age, race
108,772 men and 226,067 women
Lifetime nonsmokers
CPS-II data
United States
6Spouse smokedDeath from CHDWomen: 1.0 (0.98–1.1)
Men: 0.97 (0.9–1.1)
Age, race
Steenland et al. 1996 126,500 men and 353,180 women
Lifetime nonsmokers
Aged ≥30 years
CPS-II data
United States
8Home and workplace exposures and spousal smoking (self-reported)Death from CHD1.21 (1.06–1.39)Age, heart disease history, hypertension, diabetes mellitus, arthritis, BMI, level of education, aspirin use, diuretic use, estrogen use, alcohol consumption, exercise, employment status
Kawachi et al. 1997 32,046 female nurses
Lifetime nonsmokers
Aged 36–61 years
300,325 person-years
United States
10Home or workplace exposure in 1982Myocardial infarction and death from CHD1.71 (1.03–2.84)Age, follow-up period, alcohol consumption, BMI, hypertension, diabetes mellitus, hypercholesterolemia, menopausal status, current use of postmenopausal hormones, past use of oral contraceptives, vigorous exercise, saturated fat intake, vitamin E intake, average aspirin use, parental history of myocardial infarction before 60 years of age, father’s occupation when participant was 16 years of age

Note: All studies appear in both the original review and updated meta-analysis unless otherwise indicated.


CPS-I = Cancer Prevention Study I, American Cancer Society cohort.

CPS-II = Cancer Prevention Study II, American Cancer Society cohort.

Person-years = Duration of exposure to secondhand smoke (cumulative).

From: 8, Cardiovascular Diseases from Exposure to Secondhand Smoke

Cover of The Health Consequences of Involuntary Exposure to Tobacco Smoke
The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General.
Office on Smoking and Health (US).

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