Background: Emerging studies have assessed the association between secondhand smoke (SHS) exposure and
cardiovascular disease (CVD) aswell as all-causemortality.However, findings were not consistent due to the heterogeneity
of study characteristics.
Methods: PubMed and Embasewere searched throughMay 2014 for prospective cohort and case–control studies
investigating the associations of SHS exposure in never smokers with all-cause mortality and the risk of CVD. The
main analysis was performed in studies using self-reported SHS exposure and secondary analysis was performed
in studies using objectively measured SHS exposure. Summary estimates were calculated using random-effects
models.
Results: Twenty-three prospective and 17 case–control studies were included. The pooled relative risks (RR) for
never smokers exposed to SHS in comparison with those unexposed were 1.18 [95% confidence interval (CI):
1.10–1.27] for all-cause mortality (12 studies), and 1.23 (1.16–1.31) for CVD (38 studies). The association of
SHS exposure with CVD was markedly stronger among studies conducted in China (RR = 1.65, 95% CI 1.27–
2.13) than that in the US (RR = 1.09, 95% CI 1.03–1.16). Studies using objectively measured SHS exposure
demonstrated a slightly higher risk for CVD compared with those using self-reported SHS exposure.
Conclusions: Exposure to SHS significantly increased the risk for all-cause mortality and CVD. The risk associated
with SHS exposure was large in China while the risk was only modest in the US. Studies using objectively
measured SHS exposure may yield a higher risk of CVD than those using self-reported SHS exposure.