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
- 1Section of Public Health, University of Glasgow, UK
- 2NHS Health Scotland, Edinburgh, UK
- 3BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
- 4BHF Glasgow Centre for Cardiovascular Science, University of Edinburgh, UK
- 5Monklands Hospital, Airdrie, UK
- 6Information Services Division, Edinburgh, UK
- 7Department of Cardiology, University of Dundee, UK
- 8Southern General Hospital, Glasgow, UK
- 9Stobhill Hospital, Glasgow, UK
- 10West of Scotland Heart and Lung Centre, Glasgow, UK
- 11Royal Alexandra Hospital, Paisley, UK
- 12Hairmyres Hospital, East Kilbride, UK
- 13Department of Biochemistry, Western Infirmary, Glasgow, UK
- 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;
- Accepted 28 April 2009
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 (χ2 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.
Funding NHS Health Scotland project grant.
Competing interests None.
See Featured editorial, p 1377