Protecting Europeans from secondhand smoke: time to actThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

This editorial refers to ‘Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm’† by T. Raupach et al ., on page 386 Raupach et al .1 provide a concise review of the effects of secondhand smoke on the cardiovascular system that complements recent reviews2,3 to synthesize the clinical and experimental evidence that secondhand smoke has rapid and large effects on platelet activation, endothelial function, and myocardial oxygen balance. The effects of secondhand smoke on these important mediators of cardiac function are both direct and indirect, acting through vascular inflammation, and changes in autonomic function. As these changes affect long-term risks, such as developing atheroschlerotic heart disease, most of the effect is immediate (within minutes) and capable of triggering or worsening acute cardiac events. The authors conclude, ‘clinicians need to inform their patients about the risks associated with passive smoking and strongly support the enforcement of smoking bans in all public places.’ This advice comes at an important time for cardiologists and others concerned with heart health in Europe, where the movement for smoke-free air has finally arrived. This … *Corresponding author. Tel: +1 415 476 3893; fax: +1 415 514 9345. E-mail address : glantz{at}medicine.ucsf.edu