Abstract
Introduction: A dose-related association between secondhand tobacco smoke (SHTS) and coronary artery calcium (CAC) has been reported, but the total extent of atherosclerosis has not been investigated. Objective: To assess the relationship of the extent of atherosclerosis on coronary computed tomographic angiography (CTA) to the extent of secondhand tobacco smoke (SHTS) exposure in asymptomatic never smokers. Methods: Two hundred sixty eight never smokers, aged 40-80, completed a risk factor and extent of lifetime SHTS exposure questionnaire providing a total SHTS exposure score. Analyses of the prevalence, extent and plaque characteristics of atherosclerosis on CTA were performed and the independent contribution of SHTS was determined. Results: Coronary atherosclerosis was noted in 48% and was more frequent with low/moderate and high versus minimal SHTS exposure (48% and 69% vs. 25%, P < 0.0001). >50% stenosis, 1-49% stenosis and no stenosis were noted in 6%, 42% and 52% respectively. Adjusted ORs for any atherosclerosis were: 2.1 (95% CI: 1.0-4.4, P=0.05) for low-moderate and 3.5 (95% CI: 1.4-8.5, P=0.01) for high versus minimal SHTS exposure and were not significant for diabetes (P=0.45), hyperlipidemia (P=0.11), hypertension (P=0.65), and renal disease (P=0.24). With increasing SHTS exposure, the number of major vessels (P=0.0013), and the number of segments with any atherosclerosis (p=0.0001) significantly increased as did the number of involved segments with any plaque or stenosis (P < 0.0001), with calcified plaques alone (P <0.0001), with calcified and mixed plaques (P < 0.001) but not noncalcified plaques alone (P = 0.11). Conclusions: The presence and extent of atherosclerosis were associated with the extent of SHTS exposure even when adjusted for other risk factors, further demonstrating the causal relationship of SHTS exposure and coronary disease.
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