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Gerrit Bruintjes; Mori J. Krantz, MD

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We were initially surprised by the study completed by Stranges and colleagues¹ showing no significant increase in acute myocardial infarction (AMI) related to lifetime secondhand smoke (SHS) exposure. The authors reported a nonsignificant increase in the odds ratio (OR) for AMI when comparing the lowest with the highest SHS exposure tertiles (OR, 1.19; 95% confidence interval, 0.78-1.82). A crude OR between these 2 groups, however, demonstrates more than a doubling of AMI risk (approximately 2.20). We suggest that the relatively small sample size and the low inclusion percentage (67% of total population reduced to 19% never smokers), along with the variability of self-reported exposure data spanning over 35 years, make a nonsignificant result no longer surprising. As the authors acknowledged, an OR of 1.19 is also quantitatively identical to previous epidemiologic assessments of the risk of AMI associated with SHS exposure.²

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RELATED LETTER

Acute vs Chronic Secondhand Smoke Exposure—Reply
Saverio Stranges, Matthew R. Bonner, Federica Fucci, K. Michael Cummings, Jo L. Freudenheim, Joan M. Dorn, Paola Muti, Gary A. Giovino, Andrew Hyland, and Maurizio Trevisan
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