Fifty years have elapsed since publication of the landmark Royal College of Physicians' Report ‘Smoking and health’, which was instrumental in raising public awareness of the adverse health effects of smoking. In spite of the passage of time, smoking remains a major cause of cardiovascular morbidity and mortality. Unsurprisingly, the first international treaty negotiated under the auspices of the WHO was the ‘Framework convention on tobacco control’. Following adoption by the World Health Assembly in 2003, it acquired 168 signatories, making it one of the most rapidly and widely embraced treaties in the United Nations. The framework outlined a list of complementary recommendations that included protection from exposure to secondhand tobacco smoke.

Cardiovascular disease is only one of the conditions to which secondhand smoke exposure predisposes. However, the relationship between secondhand smoke and cardiovascular disease is of particular concern because the risk is disproportionately high at relatively low levels of exposure. Side stream smoke contains high levels of toxins and small respirable …