He J, Vupputuri S, Allen K, Prerost M R, Hughes J, Whelton P K
Department of Biostatistics and Epidemiology, Prevention Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
N Engl J Med. 1999 Mar 25;340(12):920-6. doi: 10.1056/NEJM199903253401204.
The effect of passive smoking on the risk of coronary heart disease is controversial. We conducted a meta-analysis of the risk of coronary heart disease associated with passive smoking among nonsmokers.
We searched the Medline and Dissertation Abstracts Online data bases and reviewed citations in relevant articles to identify 18 epidemiologic (10 cohort and 8 case-control) studies that met prestated inclusion criteria. Information on the designs of the studies, the characteristics of the study subjects, exposure and outcome measures, control for potential confounding factors, and risk estimates was abstracted independently by three investigators using a standardized protocol.
Overall, nonsmokers exposed to environmental smoke had a relative risk of coronary heart disease of 1.25 (95 percent confidence interval, 1.17 to 1.32) as compared with nonsmokers not exposed to smoke. Passive smoking was consistently associated with an increased relative risk of coronary heart disease in cohort studies (relative risk, 1.21; 95 percent confidence interval, 1.14 to 1.30), in case-control studies (relative risk, 1.51; 95 percent confidence interval, 1.26 to 1.81), in men (relative risk, 1.22; 95 percent confidence interval, 1.10 to 1.35), in women (relative risk, 1.24; 95 percent confidence interval, 1.15 to 1.34), and in those exposed to smoking at home (relative risk, 1.17; 95 percent confidence interval, 1.11 to 1.24) or in the workplace (relative risk, 1.11; 95 percent confidence interval, 1.00 to 1.23). A significant dose-response relation was identified, with respective relative risks of 1.23 and 1.31 for nonsmokers who were exposed to the smoke of 1 to 19 cigarettes per day and those who were exposed to the smoke of 20 or more cigarettes per day, as compared with nonsmokers not exposed to smoke (P=0.006 for linear trend).
Passive smoking is associated with a small increase in the risk of coronary heart disease. Given the high prevalence of cigarette smoking, the public health consequences of passive smoking with regard to coronary heart disease may be important.
被动吸烟对冠心病风险的影响存在争议。我们对非吸烟者中与被动吸烟相关的冠心病风险进行了一项荟萃分析。
我们检索了医学文献数据库（Medline）和在线论文摘要数据库，并查阅了相关文章中的参考文献，以确定18项符合预先设定纳入标准的流行病学研究（10项队列研究和8项病例对照研究）。三位研究人员使用标准化方案独立提取有关研究设计、研究对象特征、暴露和结局测量、潜在混杂因素的控制以及风险估计等信息。
总体而言，与未接触烟雾的非吸烟者相比，接触环境烟雾的非吸烟者患冠心病的相对风险为1.25（95%置信区间为1.17至1.32）。在队列研究（相对风险为1.21；95%置信区间为1.14至1.30）、病例对照研究（相对风险为1.51；95%置信区间为1.26至1.81）、男性（相对风险为1.22；95%置信区间为1.10至1.35）、女性（相对风险为1.24；95%置信区间为1.15至1.34）以及在家中（相对风险为1.17；95%置信区间为1.11至1.24）或工作场所接触吸烟的人群（相对风险为1.11；95%置信区间为1.00至1.23）中，被动吸烟始终与冠心病相对风险增加相关。确定了显著的剂量反应关系，与未接触烟雾的非吸烟者相比，每天接触1至19支香烟烟雾的非吸烟者和每天接触20支或更多香烟烟雾的非吸烟者的相对风险分别为1.23和1.31（线性趋势P = 0.006）。
被动吸烟与冠心病风险的小幅增加相关。鉴于吸烟的高流行率，被动吸烟对冠心病的公共卫生影响可能很大。
