Environmental tobacco smoke exposure and heart disease: A systematic review

Table 3 Heart disease relative risk estimates used in the main analysis for spouse ever smoked (or nearest equivalent) and in sensitivity analyses for spouse a current smoker, as well as additional results for household exposure

			Exposure index
Study No.1	Author2	Sex	Source3	Timing4	Fatality5	Relative risk (95%CI)6
Results used in the main analysis7
1	Hirayama[29]	F	S	E	F	1.16 (0.94-1.43)8
2	Garland et al[30]	F	S	E	F	2.70 (0.63-11.58)
3	Lee et al[31]	M	S	M	NF	1.24 (0.58-2.67)
		F	S	M	NF	0.93 (0.53-1.64)
4	Martin et al[32]	F	S	E	NF	2.60 (1.20-5.70)9
5	Svendsen et al[33]	M	S	C	F + NF	1.61 (0.96-2.71)
6	Butler[34]	F	S	E	F	1.07 (0.65-1.75)
7	Palmer et al[35]	F	S	E	NF	1.20
8	Hole et al[36]	M	H10	E	F	1.73 (1.01-2.96)11
		F	H10	E	F	1.65 (0.79-3.46)11
9	Jackson[37]	M	H	C	F + NF	1.06 (0.39-2.91)
		F	H	C	F + NF	3.74 (1.15-12.19)
10	Sandler et al[38]	M	H	C	F	1.31 (1.05-1.64)
		F	H	C	F	1.19 (1.04-1.36)
11	Humble et al[39]	F	S	C(N)	F	1.59 (0.99-2.57)
12	Dobson et al[40]	M	H	C	F + NF	0.97 (0.50-1.86)
		F	H	C	F + NF	2.46 (1.47-4.13)
13	Gardiner et al[41]	M + F	S	M	F + NF	0.57 (0.19-1.74)
14	La Vecchia et al[42]	M	S	E	NF	1.09 (0.47-2.53)
		F	S	E	NF	1.27 (0.52-3.09)
15	Layard[25]	M	S	E	F	0.97 (0.73-1.28)
		F	S	E	F	0.99 (0.84-1.16)
16	Le Vois et al[26] (CPS I)	M	S	E	F	0.97 (0.90-1.05)
		F	S	E	F	1.03 (0.98-1.08)
17	Mannino et al[43]	M + F	H	C	NF	1.12
18	Muscat et al[44]	M	S	E	NF	1.38 (0.70-2.75)
		F	S	E	NF	1.33 (0.59-2.99)
19	Tunstall-Pedoe et al[45]	M + F	T	C	NF	1.34 (1.07-1.67)
20	Steenland et al[46]	M	S	E	F	1.09 (0.98-1.21)
		F	S	E	F	1.04 (0.93-1.16)
21	Janghorbani et al[47]	F	S	E	NF	1.38 (0.95-2.01)
22	Kawachi et al[48]	F	H	C	F + NF	1.53 (0.81-2.90)9
23	Ciruzzi et al[49]	M	S	C	NF	1.18 (0.55-2.52)
		F	S	C	NF	1.73 (0.89-3.36)
24	McElduff et al[50]	M	T	C	F + NF	0.82 (0.55-1.22)
		F	T	C	F + NF	2.15 (1.18-3.92)
25	Spencer et al[51]	M	H	E	NF	No significant association
26	He et al[52]	F	S	E	NF	1.60 (0.94-2.90)
27	Iribarren et al[53]	M	H	C	NF	1.13 (1.00-1.27)
		F	H	C	NF	1.20 (1.09-1.30)
28	Rosenlund et al[54]	M	S	E	NF	0.96 (0.64-1.44)
		F	S	E	NF	1.53 (0.95-2.44)
29	Pitsavos et al[55]	M + F	H	C	NF	1.33 (0.89-1.99)
30	Enstrom et al[27]	M	S	E	F	0.93 (0.83-1.04)
		F	S	E	F	0.99 (0.92-1.08)
31	Chen et al[56]	M + F	H	C	NF	1.20 (0.70-2.20)
32	Nishtar et al[57]	M + F	S	E	NF	2.38 (1.04-5.42)
34	McGhee et al[59]	M	H	P	F	1.30 (0.88-1.93)
		F	H	P	F	1.39 (0.95-2.04)
35	Qureshi et al[60]	F	S	E	F + NF	1.05 (0.81-1.38)12
37	Stranges et al[62]	M	H	E	NF	0.98 (0.65-1.50)
		F	H	E	NF	1.30 (0.67-2.51)
38	Teo et al[63]	M + F	T	C	NF	1.37 (1.27-1.48)
39	Wen et al[64]	F	S	M	F	0.99 (0.72-1.37)13
41	Hill et al[66]	M	H	C	F	1.04 (0.88-1.23)
		F	H	C	F	0.98 (0.83-1.17)
42	Hill et al[66]	M	H	C	F	1.18 (0.96-1.44)
		F	H	C	F	1.27 (0.98-1.66)
43	He et al[67]	F	T	T	NF	1.69 (1.31-2.18)
44	Sulo et al[68]	M	S	C	NF	1.68 (0.81-3.47)
		F	S	C	NF	1.19 (0.25-5.64)
45	Vozoris et al[69]	M + F	T	C	NF	1.00 (0.80-1.20)
46	Ding et al[70]	F	H	E	NF	1.52 (1.01-2.27)
47	Gallo et al[71]	M + F	S	C	F	1.99 (0.92-4.29)14
49	Jefferis et al[73]	M + F	S	C	F + NF	2.41 (1.04-5.59)
50	Peinemann et al[74]	M + F	T	C	NF	1.27 (0.84-1.92)
51	Chen[75]	M + F	T	E	NF	1.16 (0.93-1.45)15
52	He et al[76]	M	T	E	F	2.24 (0.76-6.59)
		F	T	E	F	2.10 (0.69-6.33)
53	Clark et al[77]	M	H	C	F	1.98 (1.00-3.93)
		F	H	C	F	0.94 (0.67-1.32)
54	Iversen et al[78]	M	H	A	F + NF	0.91 (0.61-1.35)
		F	H	A	F + NF	1.42 (1.06-1.90)
55	Kastorini et al[79]	M + F	T	E	NF	4.33 (1.52-12.38)
56	Rostron[80]	M + F	H	C	F	0.82 (0.39-1.70)
57	Batty et al[81]	M	H	C	F	1.26 (0.37-4.31)
		F	H	C	F	1.12 (0.55-2.28)
58	Shiue[82]	M + F	T	C	NF	1.47 (0.96-2.24)
Alternative result used in the analysis of spouse a current smoker
2	Garland et al[30]	F	S	C(N)	F	2.25 (0.32-15.74)
4	Martin et al[32]	F	S	C	NF	3.40
6	Butler[34]	F	S	C(N)	F	1.40 (0.51-3.84)
14	La Vecchia et al[42]	M	S	C(N)	NF	1.09 (0.39-3.01)
		F	S	C(N)	NF	1.36 (0.46-4.05)
16	Le Vois et al[26] (CPS I)	M	S	C(N)	F	0.98 (0.91-1.06)
		F	S	C(N)	F	1.04 (0.99-1.09)
20	Steenland et al[46]	M	S	C(N)	F	1.22 (1.07-1.40)
		F	S	C(N)	F	1.10 (0.96-1.27)
28	Rosenlund et al[54]	M	S	C(N)	NF	0.98 (0.57-1.69)
		F	S	C(N)	NF	2.59 (1.27-5.29)
30	Enstrom et al[27]	M	S	C(N)	F	0.92 (0.80-1.05)
		F	S	C(N)	F	0.97 (0.89-1.06)
37	Stranges et al[62]	M	H	C	NF	0.71 (0.40-1.23)
		F	H	C	NF	0.94 (0.48-1.82)
39	Wen et al[64]	F	S	C	F	1.19 (0.84-1.67)16
Additional household exposure results
18	Muscat et al[44]	M	H	E	NF	1.40 (0.70-2.81)
		F	H	E	NF	1.55 (0.55-4.37)
20	Steenland et al[46]	M	H	C(N)	F	1.15 (1.01-1.32)
		F	H	C(N)	F	1.07 (0.98-1.17)
21	Janghorbani et al[47]	F	H	E	NF	1.34 (0.94-1.91)
23	Ciruzzi et al[49]	M	H17	C	NF	1.89 (1.13-3.18)
		F	H17	C	NF	1.54 (0.95-2.51)
47	Gallo et al[71]	M + F	H	C	F	1.31 (0.83-2.08)18

¹Study 40 omitted as results only available per 10 years of living with a smoker. Studies 33, 36 and 48 omitted as they only provide results for a biochemical index of ETS exposure;

²First author of paper;

³S: Spouse (or partner), H: Household member (or exposure at home), T: Total;

⁴E: Ever exposed (compared to never exposed) or unspecified; M: During marriage; C(N): Current exposure (compared to never exposed); C: Current exposure (compared to non-current exposure), P: In the past, T: In the last 10 years, A: In adulthood;

⁵F: Fatal; NF: Non-fatal; F + NF indicates combined results were analysed;

⁶Relative risks are adjusted for covariates if adjusted data are available. Those without 95%CI are not used in the meta-analyses;

⁷Except where lacking a 95%CI, as in studies 7, 17 and 25;

⁸Adjusted for the age of the husband. Alternative estimates[115] were very similar;

⁹Estimates given by Wells[1];

¹⁰Cohabitant(s) age 45-64 also attending screening;

¹¹Estimates given by Wells[116];

¹²Result for CVD - Stroke. Result also available for CVD: 1.00 (0.81-1.24);

¹³Result for CVD - Stroke. Result also available for CVD: 1.18 (0.92-1.51);

¹⁴Result for CVD. Result for IHD shown in the “household” section of this table;

¹⁵Result for IHD. Result also available for myocardial infarction: 0.93 (0.66-1.31);

¹⁶Result for CVD - Stroke. Results also available for CVD: 1.37 (1.06-1.78);

¹⁷Smoking by close relatives (although not necessarily living in same home);

¹⁸Result for IHD. Result also available for CVD: 1.82 (1.06-3.12). ETS: Environmental tobacco smoke; CVD: Cardiovascular disease; IHD: Ischaemic heart disease; CPS: Cancer Prevention Studies.