Author + information
- Matthew J. Budoff, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Matthew J. Budoff, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, California 90502.
There is little doubt that secondhand smoke (SHS) is causative in future coronary artery disease (CAD) events. The Surgeon General includes such a warning, and several large studies have confirmed this association among those who have never smoked. However, being able to individualize and quantitate SHS risk has been elusive. Population-based studies are fine to identify a risk factor, but do little to inform the individual as to whether they are personally affected. SHS clearly has implications for increased atherosclerosis. One early study (1) evaluated coronary artery calcium (CAC) and found a positive association with SHS exposure. Yankelevitz et al. (2) demonstrates in a large cohort study that SHS is independently associated with the prevalence and extent of subclinical atherosclerosis. This study, with careful questioning about all aspects of exposure (childhood, work, home), proved a quantitative relationship in those who never smoked between SHS exposure and CAC. It also showed that childhood, home, and work exposure all independently predicted prevalence of CAC. The strongest independent association was the adult at-work exposure (p = 0.0007). Further, it established that a significant dose relationship exists, with increasing SHS exposure associated with increased CAC. This would argue strongly for better tobacco restrictions in the workplace, to reduce the cardiovascular risk of those who never smoke. There is no doubt that CAC imparts significant cardiovascular risk, with a score >100 imparting over a 10-fold risk of future cardiovascular events, as documented by the Multi-Ethnic Study of Atherosclerosis (3). The American College of Cardiology/American Heart Association guidelines for the assessment of cardiovascular risk provides a Class IIa recommendation for use in intermediate risk and persons with diabetes (4). This further fuels the fire for more restrictions on smoke in the workplace, and of course, in other public venues.
These types of studies, quantifying the risks of SHS in public places, are critical to validating the restrictions. However, although bans on smoking in public places continue to increase nationwide, there can be little done related to at-home exposures. The current study demonstrates that childhood and home exposures are independently predictive of CAC, and thus, have important long-term implications for these patients. Thus, children and spouses of smokers bear the risk, without partaking in the at-risk behavior. It is likely that only public education can have an impact at home, allowing those who smoke to better understand the ramifications for those around them. More studies are necessary, but these implications are clear, and both public service announcements, continued legislation, and warnings from the Surgeon General can help reach out to help protect this vulnerable population.
↵∗ Editorials published in JACC: Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Imaging or the American College of Cardiology.
Dr. Budoff has received grant support from General Electric. Sherif Nagueh, MD, served as Guest Editor for this paper.
- American College of Cardiology Foundation
- Yankelevitz D.F.,
- Henschke C.I.,
- Yip R.,
- et al.
- Greenland P.,
- Alpert J.S.,
- Beller G.A.,
- et al.