title: Secondhand smoke exposure and survival following acute coronary syndrome: prospective cohort study of 1261 consecutive admissions among never-smokers.
abstract: OBJECTIVE
  To determine whether exposure to secondhand smoke is associated with early prognosis following acute coronary syndrome.
  
  
  METHODS
  We interviewed consecutive patients admitted to nine Scottish hospitals over 23 months. Information was obtained, via questionnaire, on age, sex, smoking status, postcode of residence and admission serum cotinine concentration was measured. Follow-up data were obtained from routine hospital admission and death databases.
  
  
  RESULTS
  Of the 5815 participants, 1261 were never-smokers. Within 30 days, 50 (4%) had died and 35 (3%) had a non-fatal myocardial infarction. All-cause deaths increased from 10 (2.1%) in those with cotinine < or =0.1 ng/ml to 22 (7.5%) in those with cotinine >0.9 ng/ml (chi(2) test for trend p<0.001). This persisted after adjustment for potential confounders (cotinine >0.9 ng/ml: adjusted OR 4.80, 95% CI 1.95 to 11.83, p = 0.003). The same dose response was observed for cardiovascular deaths and death or myocardial infarction.
  
  
  CONCLUSIONS
  Secondhand smoke exposure is associated with worse early prognosis following acute coronary syndrome. Non-smokers need to be protected from the harmful effects of secondhand smoke.
authors.affiliation: Section of Public Health, University of Glasgow, UK. j.pell@clinmed.gla.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Pell
authors.forename: S
authors.initials: S
authors.lastname: Haw
authors.forename: S
authors.initials: S
authors.lastname: Cobbe
authors.forename: D E
authors.initials: DE
authors.lastname: Newby
authors.forename: A C H
authors.initials: AC
authors.lastname: Pell
authors.forename: C
authors.initials: C
authors.lastname: Fischbacher
authors.forename: S
authors.initials: S
authors.lastname: Pringle
authors.forename: D
authors.initials: D
authors.lastname: Murdoch
authors.forename: F
authors.initials: F
authors.lastname: Dunn
authors.forename: K
authors.initials: K
authors.lastname: Oldroyd
authors.forename: P
authors.initials: P
authors.lastname: MacIntyre
authors.forename: B
authors.initials: B
authors.lastname: O'Rourke
authors.forename: W
authors.initials: W
authors.lastname: Borland
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003367:Cotinine / Q000097:blood; D004781:Environmental Exposure / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000032:analysis
chemical_list: D015415:Biomarkers; D014028:Tobacco Smoke Pollution; D003367:Cotinine