BMJ, doi:10.1136/bmj.38146.427188.55 (published 30 June 2004)

PAPERS

Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement

Peter H Whincup ¹, Julie A Gilg ¹, Jonathan R Emberson ², Martin J Jarvis ³, Colin Feyerabend ⁴, Andrew Bryant ⁴, Mary Walker ², Derek G Cook ¹

¹ Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE
² Department of Primary Care and Population Sciences, Royal Free Campus, Royal Free and University College Medical School, London NW3 2PF
³ Cancer Research UK Health Behaviour Research Unit, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London WC1E 6BT
⁴ Medical Toxicology Unit, New Cross Hospital, London SE14 5ER

Objective To examine the associations between a biomarker of overall passive exposure to tobacco smoke (serum cotinine concentration) and risk of coronary heart disease and stroke.

Design Prospective population based study in general practice (the British regional heart study).

Participants 4729 men in 18 towns who provided baseline blood samples (for cotinine assay) and a detailed smoking history in 1978-80.

Main outcome measure Major coronary heart disease and stroke events (fatal and non-fatal) during 20 years of follow up.

Results 2105 men who said they did not smoke and who had cotinine concentrations <14.1 ng/ml were divided into four equal sized groups on the basis of cotinine concentrations. Relative hazards (95% confidence intervals) for coronary heart disease in the second (0.8-1.4 ng/ml), third (1.5-2.7 ng/ml), and fourth (2.8-14.0 ng/ml) quarters of cotinine concentration compared with the first (0.7 ng/ml) were 1.45 (1.01 to 2.08), 1.49 (1.03 to 2.14), and 1.57 (1.08 to 2.28), respectively, after adjustment for established risk factors for coronary heart disease. Hazard ratios (for cotinine 0.8-14.0 v 0.7 ng/ml) were particularly increased during the first (3.73, 1.32 to 10.58) and second five year follow up periods (1.95, 1.09 to 3.48) compared with later periods. There was no consistent association between cotinine concentration and risk of stroke.

Conclusion Studies based on reports of smoking in a partner alone seem to underestimate the risks of exposure to passive smoking. Further prospective studies relating biomarkers of passive smoking to risk of coronary heart disease are needed.

---

(Accepted 6 May 2004)

Related Articles

Exempting mental health units from smoke-free laws

Jonathan Campion, Ann McNeill, and Ken Checinski
BMJ 2006 333: 407-408. [Extract] [Full Text] [PDF]

Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study

Wanqing Wen, Xiao Ou Shu, Yu-Tang Gao, Gong Yang, Qi Li, Honglan Li, and Wei Zheng
BMJ 2006 333: 376. [Abstract] [Full Text] [PDF]

Best estimates of coronary risk of passive smoking are needed

Ruoling Chen, Hugh Tunstall-Pedoe, and Roger Tavendale
BMJ 2004 329: 918. [Extract] [Full Text]

Passive smoking increases the risk of heart disease
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

• Campion, J., Checinski, K., Nurse, J., McNeill, A. (2008). Smoking by people with mental illness and benefits of smoke-free mental health services. Adv. Psychiatr. Treat. 14: 217-228 [Abstract] [Full text]  
• Al-Delaimy, W. K., Stampfer, M. J., Manson, J. E., Willett, W. C. (2008). Toenail Nicotine Levels as Predictors of Coronary Heart Disease among Women. Am J Epidemiol 0: kwn061v1-kwn061 [Abstract] [Full text]  
• Lopez, M J, Perez-Rios, M, Schiaffino, A, Nebot, M, Montes, A, Ariza, C, Garcia, M, Juarez, O, Moncada, A, Fernandez, E (2007). Mortality attributable to passive smoking in Spain, 2002. Tobacco Control 16: 373-377 [Abstract] [Full text]  
• Juster, H. R., Loomis, B. R., Hinman, T. M., Farrelly, M. C., Hyland, A., Bauer, U. E., Birkhead, G. S. (2007). Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban. Am. J. Public Health 97: 2035-2039 [Abstract] [Full text]  
• Tong, E. K., Glantz, S. A. (2007). Tobacco Industry Efforts Undermining Evidence Linking Secondhand Smoke With Cardiovascular Disease. Circulation 116: 1845-1854 [Abstract] [Full text]  
• Haw, S. J, Gruer, L. (2007). Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ 335: 549-549 [Abstract] [Full text]  
• Kallio, K., Jokinen, E., Raitakari, O. T., Hamalainen, M., Siltala, M., Volanen, I., Kaitosaari, T., Viikari, J., Ronnemaa, T., Simell, O. (2007). Tobacco Smoke Exposure Is Associated With Attenuated Endothelial Function in 11-Year-Old Healthy Children. Circulation 115: 3205-3212 [Abstract] [Full text]  
• Venn, A., Britton, J. (2007). Exposure to Secondhand Smoke and Biomarkers of Cardiovascular Disease Risk in Never-Smoking Adults. Circulation 115: 990-995 [Abstract] [Full text]  
• Hedblad, B., Engstrom, G., Janzon, E., Berglund, G., Janzon, L. (2006). COHb% as a marker of cardiovascular risk in never smokers: Results from a population-based cohort study. Scand J Public Health 34: 609-615 [Abstract]  
• Stranges, S., Bonner, M. R., Fucci, F., Cummings, K. M., Freudenheim, J. L., Dorn, J. M., Muti, P., Giovino, G. A., Hyland, A., Trevisan, M. (2006). Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western new york health study, 1995-2001.. Arch Intern Med 166: 1961-1967 [Abstract] [Full text]  
• Bartecchi, C., Alsever, R. N., Nevin-Woods, C., Thomas, W. M., Estacio, R. O., Bartelson, B. B., Krantz, M. J. (2006). Reduction in the Incidence of Acute Myocardial Infarction Associated With a Citywide Smoking Ordinance. Circulation 114: 1490-1496 [Abstract] [Full text]  
• Campion, J., McNeill, A., Checinski, K. (2006). Exempting mental health units from smoke-free laws.. BMJ 333: 407-408 [Full text]  
• Wen, W., Shu, X. O., Gao, Y.-T., Yang, G., Li, Q., Li, H., Zheng, W. (2006). Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study. BMJ 333: 376- [Abstract] [Full text]  
• Jaakkola, M. S., Jaakkola, J. J. K. (2006). Impact of smoke-free workplace legislation on exposures and health: possibilities for prevention.. Eur Respir J 28: 397-408 [Abstract] [Full text]  
• The GTSS Collaborative Group, (2006). A cross country comparison of exposure to secondhand smoke among youth.. Tobacco Control 15: ii4-ii19 [Abstract] [Full text]  
• Thomson, G., Wilson, N., Howden-Chapman, P. (2006). Population level policy options for increasing the prevalence of smokefree homes.. J. Epidemiol. Community Health 60: 298-304 [Abstract] [Full text]  
• Hedley, A. J., McGhee, S. M., Repace, J. L., Wong, L.-C., Yu, M. Y. S., Wong, T.-W., Lam, T.-H. (2006). Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry. Toxicol Sci 90: 539-548 [Abstract] [Full text]  
• Hart, C L, Davey Smith, G, Hole, D J, Hawthorne, V M (2006). Carboxyhaemoglobin concentration, smoking habit, and mortality in 25 years in the Renfrew/Paisley prospective cohort study. Heart 92: 321-324 [Abstract] [Full text]  
• Twardella, D., Rothenbacher, D., Hahmann, H., Wusten, B., Brenner, H. (2006). The Underestimated Impact of Smoking and Smoking Cessation on the Risk of Secondary Cardiovascular Disease Events in Patients With Stable Coronary Heart Disease: Prospective Cohort Study. J Am Coll Cardiol 47: 887-889 [Full text]  
• Raupach, T., Schafer, K., Konstantinides, S., Andreas, S. (2006). Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm. Eur Heart J 27: 386-392 [Abstract] [Full text]  
• Mulcahy, M, Evans, D S, Hammond, S K, Repace, J L, Byrne, M (2005). Secondhand smoke exposure and risk following the Irish smoking ban: an assessment of salivary cotinine concentrations in hotel workers and air nicotine levels in bars. Tobacco Control 14: 384-388 [Abstract] [Full text]  
• Chapman, S (2005). The most important and influential papers in tobacco control: results of an online poll. Tobacco Control 14: e1-e1 [Full text]  
• Emberson, J. R., Whincup, P. H., Morris, R. W., Wannamethee, S. G., Shaper, A. G. (2005). Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation. Eur Heart J 26: 1774-1782 [Abstract] [Full text]  
• Weitzman, M., Cook, S., Auinger, P., Florin, T. A., Daniels, S., Nguyen, M., Winickoff, J. P. (2005). Tobacco Smoke Exposure Is Associated With the Metabolic Syndrome in Adolescents. Circulation 112: 862-869 [Abstract] [Full text]  
• Barnoya, J., Glantz, S. A. (2005). Cardiovascular Effects of Secondhand Smoke: Nearly as Large as Smoking. Circulation 111: 2684-2698 [Abstract] [Full text]  
• Jamrozik, K. (2005). Estimate of deaths attributable to passive smoking among UK adults: database analysis. BMJ 330: 812- [Abstract] [Full text]  
• Kawachi, I. (2005). More evidence on the risks of passive smoking. BMJ 330: 265-266 [Full text]  
• Chen, R., Tunstall-Pedoe, H., Tavendale, R. (2004). Best estimates of coronary risk of passive smoking are needed. BMJ 329: 918-918 [Full text]  
• (2004). UK health minister under pressure to ban smoking in public. BMJ 329: 621-621 [Full text]  
• Laurent, C. (2004). UK health minister under pressure to ban smoking in public. BMJ 329: 368-368 [Full text]  

Rapid Responses:

Read all Rapid Responses

passive smoking

Ernest A Gildersleve
bmj.com, 30 Jun 2004 [Full text]

Re: passive smoking

Jon f pindar
bmj.com, 1 Jul 2004 [Full text]

Dietary nicotine confounds Passive Smoking estimates

David W Kuneman, et al.
bmj.com, 1 Jul 2004 [Full text]

Re: passive smoking

Adam Jacobs
bmj.com, 2 Jul 2004 [Full text]

Obviously vested interests

Bill Thompson
bmj.com, 2 Jul 2004 [Full text]

Re: Dietary nicotine confounds Passive Smoking estimates

Ginger A. Carver
bmj.com, 2 Jul 2004 [Full text]

Re: Re: passive smoking

George Vinderoot
bmj.com, 2 Jul 2004 [Full text]

Re: Re: passive smoking

Ben Hirsch
bmj.com, 2 Jul 2004 [Full text]

Poor Science

Anthony S Ward
bmj.com, 2 Jul 2004 [Full text]

Re: Re: Dietary nicotine confounds Passive Smoking estimates

Amanda D
bmj.com, 2 Jul 2004 [Full text]

Re: Dietary nicotine confounds Passive Smoking estimates

Shere Shaeffer
bmj.com, 3 Jul 2004 [Full text]

Passive smoking is like statins- both are involuntary manslaughter

Dr. Herbert H. Nehrlich
bmj.com, 3 Jul 2004 [Full text]

Drugged unwillingly

Phillip J. Colquitt
bmj.com, 3 Jul 2004 [Full text]

Re: Dietary nicotine confounds Passive Smoking estimates

David W. Kuneman
bmj.com, 4 Jul 2004 [Full text]

Politically correct nicotine

Archie D Anderson
bmj.com, 4 Jul 2004 [Full text]

Cotinine is only a marker for...cotinine

Walt Cody
bmj.com, 4 Jul 2004 [Full text]

Re: Poor Science

Anthony S Ward
bmj.com, 4 Jul 2004 [Full text]

Passive smoking & CHD

Kenneth William E. Denson, et al.
bmj.com, 4 Jul 2004 [Full text]

Re: Re: Dietary nicotine confounds Passive Smoking estimates

Adam Jacobs
bmj.com, 5 Jul 2004 [Full text]

Re: Re: Re: Dietary nicotine confounds Passive Smoking estimates

Mika Svensk
bmj.com, 6 Jul 2004 [Full text]

Pasive smoking & CHD

Dr. K.W.E. Denson, et al.
bmj.com, 6 Jul 2004 [Full text]

Fatal asymmetries

Gio B. Gori
bmj.com, 7 Jul 2004 [Full text]

Defense of cotinine marker

Sheila M Duffy
bmj.com, 14 Jul 2004 [Full text]

Re: Defense of cotinine marker

Mika Svensk
bmj.com, 15 Jul 2004 [Full text]

ETS - Stess as a Confounding Factor

Jay R. Schrand
bmj.com, 16 Jul 2004 [Full text]

'Passive Smoking' - Effects Underestimated?

Stephen J. Stotesbury, et al.
bmj.com, 19 Jul 2004 [Full text]

No reliable data from researches without considering Biophysical-Semeiotic Constitutions and Single Patient Based Medicine.

Sergio Stagnaro
bmj.com, 23 Jul 2004 [Full text]

Passive smoking and coronary heart disease

yehani wedatilake, et al.
bmj.com, 25 Jul 2004 [Full text]

Passive Smoking

John E Burgess
bmj.com, 31 Jul 2004 [Full text]

speculative claims

Sue Jeffers
bmj.com, 10 Aug 2004 [Full text]

Re: Defense of Cotinine Marker

Walt Cody
bmj.com, 11 Aug 2004 [Full text]

Poor Science - Cotinine & Risk Attenuation

Anthony S. Ward
bmj.com, 19 Aug 2004 [Full text]

Passive smoking and coronary heart disease

Hugh Tunstall-Pedoe, et al.
bmj.com, 19 Aug 2004 [Full text]