Stranges Saverio, Bonner Matthew R, Fucci Federica, Cummings K Michael, Freudenheim Jo L, Dorn Joan M, Muti Paola, Giovino Gary A, Hyland Andrew, Trevisan Maurizio
Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
Arch Intern Med. 2006 Oct 9;166(18):1961-7. doi: 10.1001/archinte.166.18.1961.
Although many epidemiologic studies have investigated the association between exposure to secondhand smoke (SHS) and risk of coronary heart disease (CHD), few of these studies have assessed exposure measures from different sources over a lifetime. Therefore, we sought to test the association between lifetime cumulative exposure to SHS and risk of myocardial infarction (MI) (as an indication of CHD) among never smokers.
A population-based case-control study in which participants were 1541 never smokers (284 cases and 1257 controls) drawn from 1197 women and men with incident MI and 2850 healthy controls (aged 35-70 years) identified from 2 Western New York counties between 1995 and 2001. Study subjects were asked to report their exposure to SHS at home, at work, and in public settings from childhood to their present age. Exposure histories from each source were combined to form a cumulative lifetime exposure measure. Multiple logistic regression analysis estimated the association between SHS exposure and case status adjusted for age, sex, education, body mass index, race, drinking status, lifetime physical activity, hypertension, diabetes mellitus, and hypercholesterolemia.
After adjustment for covariates, exposure to SHS was not significantly associated with an increased risk of MI. Compared with participants in the bottom tertile of SHS exposure, those in the top tertile had an odds ratio of 1.19 [95% confidence interval, 0.78-1.82] for MI. Virtually all subjects reported some exposure to SHS over their lifetime, but self-reported exposures declined over time, especially in the period closest to the interview.
Exposure to SHS has declined sharply among nonsmokers in recent years. In the absence of high levels of recent exposure to SHS, cumulative lifetime exposure to SHS may not be as important a risk factor for MI as previously thought.
尽管许多流行病学研究调查了二手烟暴露与冠心病风险之间的关联，但这些研究中很少有评估一生中来自不同来源的暴露测量指标。因此，我们试图检验从不吸烟者一生中二手烟累积暴露与心肌梗死（作为冠心病的一种指征）风险之间的关联。
一项基于人群的病例对照研究，参与者为1541名从不吸烟者（284例病例和1257名对照），这些参与者来自1995年至2001年间从纽约西部两个县确定的1197名发生心肌梗死的男性和女性以及2850名健康对照（年龄在35 - 70岁之间）。研究对象被要求报告从童年到目前年龄在家庭、工作场所和公共场所接触二手烟的情况。将每个来源的暴露史合并以形成累积终生暴露测量指标。多元逻辑回归分析估计了在调整年龄、性别、教育程度、体重指数、种族、饮酒状况、终生身体活动、高血压、糖尿病和高胆固醇血症后二手烟暴露与病例状态之间的关联。
在调整协变量后，二手烟暴露与心肌梗死风险增加无显著关联。与二手烟暴露处于最低三分位数的参与者相比，处于最高三分位数的参与者发生心肌梗死的比值比为1.19[95%置信区间，0.78 - 1.82]。几乎所有受试者都报告在其一生中曾接触过二手烟，但自我报告的暴露情况随时间下降，尤其是在最接近访谈的时期。
近年来，非吸烟者中二手烟暴露急剧下降。在缺乏近期高水平二手烟暴露的情况下，一生中二手烟累积暴露可能不像以前认为的那样是心肌梗死的重要危险因素。
