Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA.
Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA.
Nicotine Tob Res. 2021 Aug 18;23(9):1512-1517. doi: 10.1093/ntr/ntab047.
Serum cotinine is a sensitive and specific biomarker for tobacco exposure including second-hand smoke exposure (SHS). We sought to examine whether SHS is associated with heart failure (HF) among non-hospitalized adults.
This analysis included 11 219 non-smokers (age 48.4 ± 20.5 years, 55.9% women, 70.5% whites) from the United States Third National Health and Nutrition Examination (NHANES) years 1988-1994. SHS was defined as serum cotinine ≥1 ng/mL. To assess dose-response, cut-points of serum cotinine ≥3 ng/mL and ≥6 ng/mL were used. Multivariable logistic regression was used to examine the association between SHS and HF. The consistency of this association was tested among subgroups stratified by race, gender, and comorbidities. NHANES years 2003-2006 were examined for longitudinal comparison.
18.9% (n = 2125) of participants had SHS exposure while 3.7% (n = 416) had HF. After adjusting for covariates, SHS was associated with a 35% increased odds of HF with a dose-response relationship between levels of serum cotinine and HF. This association was stronger in males than females (interaction p-value = 0.03) and those with a history of CVD versus those without (interaction p-value < 0.001). This association persisted in the NHANES 2003-2006 analysis.
There is a dose-response relationship between SHS and HF with possible effect modification by gender and prior CVD. This is a novel finding that underscores the harmful effects of passive smoking on the cardiovascular system and highlights the needs for further prohibition of smoking in public areas and a personalized risk assessment among high-risk groups, especially in regions with less-stringent public health policies.
This study showed a novel association between secondhand smoke exposure and prevalent heart failure among non-smokers, adding to the list of harmful cardiovascular manifestations of secondhand smoke exposure. This was more apparent in men and those with a prior history of cardiovascular disease. Heart failure is a debilitating disease process, so this finding has important policy implications in low-income countries and poor communities with less-stringent health policies because they are known to have the highest levels of exposure. Smoke-free policies targeting these regions would thus yield substantial public health benefits.
血清可替宁是一种敏感且特异的生物标志物，可用于检测包括二手烟暴露（SHS）在内的烟草暴露。我们旨在研究非住院成年人中 SHS 是否与心力衰竭（HF）有关。
本分析纳入了来自美国第三次国家健康和营养检查（NHANES）1988-1994 年的 11219 名非吸烟者（年龄 48.4±20.5 岁，55.9%为女性，70.5%为白人）。SHS 定义为血清可替宁≥1ng/ml。为评估剂量反应，使用血清可替宁≥3ng/ml 和≥6ng/ml 的切点。多变量逻辑回归用于评估 SHS 与 HF 之间的关联。通过按种族、性别和合并症分层的亚组检验该关联的一致性。检查了 2003-2006 年 NHANES 数据以进行纵向比较。
18.9%（n=2125）的参与者存在 SHS 暴露，3.7%（n=416）患有 HF。调整协变量后，SHS 与 HF 的发生风险增加 35%相关，且血清可替宁水平与 HF 之间呈剂量反应关系。这种关联在男性中比女性中更强（交互 p 值=0.03），在有 CVD 病史的人群中比无 CVD 病史的人群中更强（交互 p 值＜0.001）。该关联在 2003-2006 年 NHANES 分析中仍然存在。
SHS 与 HF 之间存在剂量反应关系，且性别和既往 CVD 可能存在效应修饰。这是一项新发现，突显了被动吸烟对心血管系统的有害影响，并强调了在公共场所进一步禁烟和对高危人群进行个性化风险评估的必要性，特别是在公共卫生政策较宽松的地区。
本研究在非吸烟者中发现了 SHS 暴露与常见 HF 之间的新关联，增加了 SHS 暴露对心血管系统有害影响的证据。这种关联在男性和有既往 CVD 病史的人群中更为明显。HF 是一种使人衰弱的疾病过程，因此，在低收入国家和公共卫生政策较宽松的贫困社区，这一发现具有重要的政策意义，因为这些地区已知存在最高水平的暴露。针对这些地区的无烟政策将带来可观的公共卫生效益。
