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June 24, 1992

Environmental Tobacco Smoke and Heart Disease-Reply

Author Affiliations

National Institute for Occupational Safety and Health Cincinnati, Ohio

JAMA. 1992;267(24):3285-3286. doi:10.1001/jama.1992.03480240046025

In Reply.  —Lee is concerned that a risk of heart disease due to ETS exposure needs to be confirmed prior to developing risk assessments. However, "confirmation" is a relative matter. The weight of evidence supporting the ETS—heart disease association is accumulating; studies to date are reasonably well-designed and consistent. If there is a 25% excess risk for never-smokers living with smokers, as the data suggest, then this is a much more serious public health problem than the ETS—lung cancer issue, which has been the focus of most of the discussion to date. The purpose of my article was to draw attention to this point.Confounding by heart disease risk factors may be a problem in the ETS—heart disease studies. However, while Lee points out that two of the largest studies had no data on important risk factors,1,2 he fails to draw attention to two other large cohort studies (with