Heart Disease Studies


In the body text of this page, you will find information on studies that have documented the adverse health effects of secondhand smoke exposure on the heart.

In the orange Related Topics box at the top right of the page, you will find studies documenting the impact of smokefree air laws on heart attack rates.

This study found that "...secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease." (Groner, J.A.; Huang, H.; Joshi, M.S.; Eastman, N.; Nicholson, L.; Bauer, J.A., "Secondhand smoke exposure and preclinical markers of cardiovascular risk in toddlers," Journal of Pediatrics [Epub ahead of print], July 12, 2017.)

A meta-analysis into the effect of secondhand smoke exposure on cardiac autonomic regulation was published in the International Archives of Medicine. (Valenti, V.E.; Vanderlei, L.C.; Ferreira, C.; Fonseca, F.L.; Oliveira, F.R.; Sousa, F.H.; Rodrigues, L.M.; Monteiro, C.B.; Adami, F.; Wajnsztejn, R.; de Abreu, L.C., "Sidestream cigarette smoke and cardiac autonomic regulation," International Archives of Medicine 6(11): 1-5, March 7, 2013.)

A study published online ahead of print in the journal JACC Cardiovascular Imaging concluded that secondhand smoke exposure should be considered a risk factor for coronary artery calcification in never smokers. (Yankelevitz, D.F.; Henschke, C.I.; Yip, R.; Boffetta, P.; Shemesh, J.; Cham, M.D.; Narula, J.; Hecht, H.S., "Second-hand tobacco smoke in never smokers is a significant risk factor for coronary artery calcification," JACC Cardiovascular Imaging [Epub ahead of print], March 13, 2013.)

A study published online on February 27, 2013 in the European Journal of Epidemiology, described the results of a study from Norway into the effect of smoking and secondhand smoke exposure on heart disease in men and women. (Iversen, B.; Jacobsen, B.K.; Lochen, M.L., "Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromso Study," European Journal of Epidemiology [Epub ahead of print], February 27, 2013.)

A study published online in February 2013 examined the impact of secondhand smoke exposure on risk for asthma initiation and cancer and heart disease deaths among patrons and servers in bars and restaurants. (Liu, R.; Bohac, D.L.; Gundel, L.A.; Hewett, M.J.; Apte, M.G.; Hammond, S.K., "Assessment of risk for asthma initiation and cancer and heart disease deaths among patrons and servers due to secondhand smoke exposure in restaurants and bars," Tobacco Control [Epub ahead of print], February 13, 2013.)

A study from Iran concluded that, "Smoking and passive smoking had an increasing effect on the prevalence of risk factors of atherosclerosis and consequently the incidence of cardiovascular diseases in patients with hypertension." (Ansari, R.; Khosravi, A.; Bahonar, A.; Shirani, S.; Kelishadi, R.; Khosravi, Z., "Risk factors of atherosclerosis in male smokers, passive smokers, and hypertensive nonsmokers in Central Iran," ARYA Atherosclerosis 8(2): 90-95, Summer 2012.)

This editorial in the April 2012 "Arteriosclerosis, Thrombosis, and Vascular Biology" discussed the secondhand smoke exposure research within the issue. The authors discussed endothelial dysfunction as a biomarker of atherosclerotic progression as a possible trigger for social and public health change. Juonala et al. found that parental smoking in childhood is predictive of disrupted endothelial function (endothelium-dependent vasodilation) later in adulthood. (Suzuki, T.; Tomiyama, H.; Higashi, Y., "Vascular dysfunction even after 20 years in children exposed to passive smoking: alarming results and need for awareness," Arteriosclerosis, Thrombosis, and Vascular Biology 32: 841-842, April 2012.)

This study of teenaged, nonsmoking boys in Lhasa, Tibet, found that secondhand smoke exposure was associated with sub-clinical carotid atherosclerosis and endothelial dysfunction. The researchers argued that given the widespread nature of secondhand smoke and the poor levels of health education, it was necessary to promote smokefree environments. (Yang, B.; Li, M.; Chen, B.; Xu, Y.; Li, T.D., "Deterioration of endothelial function and carotid intima-media thickness in Tibetan male adolescents exposed to second-hand smoke," Journal of Renin-Angiotensin-Aldosterone System [Epub ahead of print], March 30, 2012.)

This Irish study found that overall hospital admissions for pulmonary illness decreased from 439 per 100,000 population to 396 per 100,000 population following implementation of the country's smokefree air law. Admissions with acute coronary syndrome, but not stroke, were also reduced. (Kent, B.D.; Sulaiman, I.; Nicholson, T.T.; Lane, S.J.; Moloney, E.D., "Acute pulmonary admssions following implementation of a national workplace smoking ban," Chest [Epub ahead of print], March 1, 2012.)

A study from Finland examined subjects at 3 and 18 years of age and again when the subjects were 28 to 45 years. Brachial artery flow-mediated dilatation was measured at follow-up with ultrasound analyses adjusting for age, sex, and childhood risk factors. Flow-mediated dilatation was reduced among participants with parents who smoked compared to those without parents who smoked. The authors suggested that secondhand smoke exposure among children led to irreversible impairment in endothelium-dependent vasodilation. (Juonala, M.; Magnussen, C.G.; Venn, A.; Gall, S.; Kähönen, M.; Laitinen, T.; Taittonen, L.; Lehtimäki, T.; Jokinen, E.; Sun, C.; Viikari, J.S.A.; Dwyer, T.; Raitakari, O.T., "Parental smoking in childhood and brachial artery flow-mediated dilatation in young adults: the Cardiovascular Risk in Young Finns study and the Childhood Determinants of Adult Health study," Thrombosis, and Vascular Biology [Epub ahead of print], February 16, 2012.)

A survey of nonsmokers who had experienced heart failure, published in the Archives of Internal Medicine, analyzed secondhand smoke exposure and Health-Related Quality of Life (HRQOL). Secondhand smoke exposure was associated with lower HRQOL scores with a reduction in physical and emotional well-being, with emotional health suffering the most. Doctors were urged to recommend that patients and families avoid secondhand smoke exposure. (Weeks, S.G.; Glantz, S.A.; De Marco, T.; Rosen, A.B.; Fleischmann, K.E., "Secondhand smoke exposure and quality of life in patients with heart failure," Archives of Internal Medicine 71(21):1887-1893, November 28, 2011.)

Warning: Secondhand Smoke is Hazardous to Your Heart- English from RPCI Health Behavior-Paul Hage on Vimeo. Video by Roswell Park Cancer Institute, World Heart Federation, World Lung Foundation, Centers for Disease Control and Prevention, and Global Smokefree Partnership.

In the October 2011 issue of BMJ Open, a study concluded that secondhand smoke exposure was independently associated with an increased risk of developing chronic obstructive pulmonary disease (COPD).

Using "Health Surveys for England," the researchers of this study found that increased secondhand smoke exposure was independently associated with an increased risk for Chronic Obstructive Pulmonary Disease [COPD] with an adjusted risk of 1.05 (95% CI 0.93 to 1.18) for 1-19 hours of exposure and a risk of 1.18 (95% CI 1.01 to 1.39) for 20 or more hours of exposure per week.

A study published in 2011 in the journal Cardiology Research and Practice reviewed 42 relevant articles into the possible effect of secondhand smoke exposure on the development of heart disease in children. The authors wrote that, "Results revealed that passive smoking may be implicated in deteriorating cardiovascular status in children in terms of unfavorable high-density lipoprotein levels and deteriorated vascular function."

A 2011 German study published in the journal Environmental Health Perspectives examined coronary artery calcification (CAC) among nonsmokers. Self-reported frequent exposure to any secondhand smoke was reported by 21.5 percent of the 1,766 nonsmokers surveyed. Secondhand smoke exposed participants had generally higher CAC values and more often CAC > 0 than non-exposed participants. In the full cohort of nonsmokers, who included 128 participants with manifest coronary heart disease (CHD), CHD was more prevalent among participants reporting secondhand smoke exposure than in the unexposed participants.

A study published in June 2010 in the Journal of the American College of Cardiology concluded that nonsmokers exposed to higher levels of secondhand smoke were twice as likely to die from heart disease as nonsmokers with lower exposure levels.

A study published online ahead of print in May 2009 in the journal Tobacco Control, concluded that never-smoking women in Hong Kong who were exposed to secondhand smoke in their homes had an increased risk of heart disease.

A study published online ahead of print on January 18, 2009 in the journal Inflammation & Allergy stated that, "Passive smoke itself, is a volatile mixture of numerous toxins, chemicals and carcinogens, that interact with in vivo mechanisms and induce vascular damage, including endothelium inflammation, atherosclerosis development, lipid peroxidisation, alterations in cytokines and acute phase proteins (such as CRP), as well as platelet aggravation. Acting alone or in synergy, the above mentioned effects suggest a causal relationship between exposure to passive smoking and the development of cardiovascular disease."

In a January 2009 study published in the American Journal of Preventive Medicine, the authors estimated that, at 1999-2004 levels of exposure, secondhand smoke caused between 21,800 and 75,100 coronary heart disease (CHD) deaths, and between 38,100 and 128,900 myocardial infarctions (MIs) each year.

A study published online ahead of print on December 10, 2008 in the journal Preventive Medicine estimated the probable decreases in acute myocardial infarction (AMI) due to implementation of a smokefree air law. The authors wrote that, "After evaluating several possible combinations of these parameters, we found that AMI reductions of 5-15% seem likely."

In a November 2008 editorial in the American Journal of Cardiology [102(10): 1421-1424], authors concluded that studies on the impact of smokefree laws on cardiovascular disease all had limitations, most notably their ecologic study designs, short-term follow-up, and lack of exposure information. Nonetheless, when taken in aggregate, these studies offer consistent evidence that smokefree laws are associated with a reduction in the risk for AMI in the general public, particularly in nonsmokers.

A study conducted by the Masschusetts Department of Public Health and the Harvard School of Public Health compared the impact of both local smokefree laws and the eventual passage of a statewide smokefree law on heart attack deaths in the state. The results show a steep decline in heart attack deaths started as Boston and most of its neighbors adopted smokefree laws. Enforcement of the statewide law beginning in mid-2004 coincided with a further reduction. From 2003 to 2006, heart attack deaths in Massachusetts plummeted 30 percent, significantly accelerating what had been a more modest long-term decline.

Click here to see a visual demonstration of how secondhand smoke exposure can impact your cardiovascular system.



Secondhand Smoke Poses Even Greater Risk for Heart Disease

A study published in the January 2009 issue of the American Journal of Preventive Medicine predicted that, "At 1999–2004 levels, passive smoking caused between 21,800 and 75,100 CHD deaths and between 38,100 and 128,900 myocardial infarctions annually. Treatment costs ranged from $1.8 to $6.0 billion per year. If recent trends in the reduction in the prevalence of passive smoking continue from 2000 to 2008, researchers predict that the burden would be reduced by approximately 25%–30%."

A study published in the May 6, 2008 issue of the Journal of the American College of Cardiology found that as little as 30 minutes of secondhand smoke exposure caused damage to the blood vessels of young adults. The lead author of the study, Christian Heiss, MD, stated, "These findings have significant public health implications and should raise further awareness of the negative side effects of even brief exposures to secondhand smoke. Our results help explain why there is a big immediate drop in heart attacks when smoke-free laws are passed."

In March 2008, research presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention stated that secondhand smoke exposure in the home "appears to induce markers for heart disease as early as the toddler years." Judith Groner, M.D., lead author of the study, pediatrician and ambulatory care physician at Nationwide Children's Hospital and Research Institute in Columbus, Ohio, stated, "This is the first study that looks at the response of a young child's cardiovascular system to secondhand smoke."

In February 2007, a study published in the journal Circulation stated that, "Passive smokers appear to have disproportionately increased levels of 2 biomarkers of cardiovascular disease risk, fibrinogen and homocysteine. This finding provides further evidence to suggest that low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease."

The August 19, 2006 issue of The Lancet, published research from McMaster University in Ontario, Canada, which determined that all types of tobacco use or exposure -- smoking, chewing, or secondhand smoke -- increase a person's risk for heart attack. The study found that secondhand smoke exposure increased the risk of heart attack among both smokers and nonsmokers, and that people with 22 or more hours of SHS exposure per week have an approximately 45 percent higher risk.

In May 2006, the Canadian Journal of Physiology and Pharmacology published a study that concluded "Even 30 min of passive smoking rapidly impairs vascular endothelial function, which is associated with oxidative stress. Our data provide the pathophysiological insight for the recent epidemiological evidence about the increased risk of coronary heart disease among nonsmokers exposed to passive smoking."

In May 2005, Circulation, the Journal of the American Heart Association, published a literature review of research into the "mechanistic effects of secondhand smoke on the cardiovascular system, emphasizing research published since 1995, and compared the effects of secondhand smoke with the effects of active smoking." The study concluded that "Secondhand smoke increases the risk of coronary heart disease by [approximately] 30%. This effect is larger than one would expect on the basis of the risks associated with active smoking and the relative doses of tobacco smoke delivered to smokers and nonsmokers."

In June 2004, the British Medical Journal published a study that found that the risks of secondhand smoke exposure are even worse than previously thought. Exposure to secondhand smoke can increase the risk of coronary heart disease by 50-60%, twice the previous estimated risk. The study supports the multitude of previous research finding that secondhand smoke exposure is a serious cause of disease and death.

The study followed more than 4,700 British men over the course of twenty years and compared the cotinine levels in their blood with their risk for heart disease and stroke. Men with higher cotinine levels demonstrated the 50-60% greater risk of heart disease. Cotinine, which is metabolized nicotine in the blood, is the most reliable measure of secondhand smoke exposure.

This study determined that previous studies that looked only at secondhand smoke exposure in the home from a smoking spouse, rather than including exposure in the workplace, significantly underestimated the risk of heart disease. The study also found that the heart disease risks were especially high for short term exposure to secondhand smoke. This supports the findings of the Helena Heart Study, which found an immediate drop in heart attacks after the city of Helena, MT enacted a smokefree workplace law.

For more information on studies showing the impact of secondhand smoke and smokefree air laws on heart disease, please see the Related Topics box at the top of this page.