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October 1, 2003

Passive Smoke Exposure and Risk of Death From Coronary Heart Disease—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(13):1708-1709. doi:10.1001/jama.290.13.1708-a

To the Editor: From the results of their systematic review, Dr Critchley and colleagues1 estimated that individuals who quit smoking have a 30% reduction in their risk of death from coronary heart disease (CHD). None of the 20 studies in this analysis, however, reported data regarding exposure to secondhand smoke (SHS). This has been a consistent flaw in most published studies on the health risk of smoking.2 In healthy nonsmokers, exposure to SHS causes acute adverse changes in coronary circulation and increases the risk of CHD mortality by about 30%.3 While there has been a 70% decrease in exposure of persons to SHS since 1988-1991, about half of US nonsmoking adults continue to be exposed chronically to SHS,4 and thus it is likely that many nonsmokers in these studies were exposed to SHS. This could result in misclassification errors because some individuals categorized as quitters may continue to be exposed to tobacco smoke. Thus, Critchley et al may have underestimated the risk of mortality between smokers and quitters.

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