Original articles

Epidemiology

Secondhand smoke exposure and survival following acute coronary syndrome: prospective cohort study of 1261 consecutive admissions among never-smokers

J P Pell¹, S Haw², S Cobbe³, D E Newby⁴, A C H Pell⁵, C Fischbacher⁶, S Pringle⁷, D Murdoch⁸, F Dunn⁹, K Oldroyd¹⁰, P MacIntyre¹¹, B O’Rourke¹², W Borland¹³

¹ Section of Public Health, University of Glasgow, UK
² NHS Health Scotland, Edinburgh, UK
³ BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
⁴ BHF Glasgow Centre for Cardiovascular Science, University of Edinburgh, UK
⁵ Monklands Hospital, Airdrie, UK
⁶ Information Services Division, Edinburgh, UK
⁷ Department of Cardiology, University of Dundee, UK
⁸ Southern General Hospital, Glasgow, UK
⁹ Stobhill Hospital, Glasgow, UK
¹⁰ West of Scotland Heart and Lung Centre, Glasgow, UK
¹¹ Royal Alexandra Hospital, Paisley, UK
¹² Hairmyres Hospital, East Kilbride, UK
¹³ Department of Biochemistry, Western Infirmary, Glasgow, UK

Correspondence to:
^{Correspondence to} Professor Jill Pell, Henry Mechan Chair in Public Health, Room 305, Public Health Section, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK; j.pell{at}clinmed.gla.ac.uk

Objective: To determine whether exposure to secondhand smoke is associated with early prognosis following acute coronary syndrome.

Design, setting and participants: We interviewed consecutive patients admitted to nine Scottish hospitals over 23 months. Information was obtained, via questionnaire, on age, sex, smoking status, postcode of residence and admission serum cotinine concentration was measured. Follow-up data were obtained from routine hospital admission and death databases.

Results: Of the 5815 participants, 1261 were never-smokers. Within 30 days, 50 (4%) had died and 35 (3%) had a non-fatal myocardial infarction. All-cause deaths increased from 10 (2.1%) in those with cotinine 0.1 ng/ml to 22 (7.5%) in those with cotinine >0.9 ng/ml (² test for trend p<0.001). This persisted after adjustment for potential confounders (cotinine >0.9 ng/ml: adjusted OR 4.80, 95% CI 1.95 to 11.83, p = 0.003). The same dose response was observed for cardiovascular deaths and death or myocardial infarction.

Conclusions: Secondhand smoke exposure is associated with worse early prognosis following acute coronary syndrome. Non-smokers need to be protected from the harmful effects of secondhand smoke.

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