See article vol. 30: 863-870
Previous studies have discussed the effects of passive smoking, or so-called secondhand smoke, on the risk of acute coronary syndromes 1 - 5) . Short-term exposure results in increased sensitivity of platelets and decreased ability of the heart to receive and process oxygen. Long term exposure results in plaque formation and adverse effects on blood cholesterol 1) . Even occasional secondhand smoke increases the risk of developing acute coronary syndromes, especially when other risk factors are present 2) . A study by Yankelevitz et al. 3) showed a significant quantitative relationship between exposure to secondhand tobacco smoke and prevalence and extent of subclinical atherosclerosis manifested by coronary artery calcification in never smokers. In an epidemiological study, the effects of secondhand smoke on cardiovascular disease were found to be substantial and rapid, which explains the relatively large risks that have been reported 4) . A recent systematic review and meta-analysis also showed that secondhand smoke is significantly associated with an increased risk of incidence and mortality of cardiovascular disease 5) .
Since the mid-1980s, there has been increasing interest in the effects of secondhand smoke on the health of children 6) . Peña et al. 7) suggested that chronic secondhand smoke exposure in childhood was associated with worse left ventricular diastolic function, whereas chronic exposure in adolescence and/or adulthood was associated with increased left arterial size. The harmful effects of secondhand smoke on cardiovascular disease remain controversial 8 , 9) . Pistilli et al. 8) reported that they observed a significant association between childhood secondhand smoke exposure and stroke but not coronary heart disease. A large-scale cross-sectional study suggested that secondhand smoke exposure during childhood is associated with the prevalence of hyperlipidemia and coronary heart disease in adulthood among non-smoking Chinese women 9) .
In a recent large-scale longitudinal study, Japanese investigators, for the first time, reported that secondhand smoke exposure in childhood is positively associated with mortality from coronary heart disease in adulthood 10) . In this study, during the median 18.9 year-follow-up, 955 coronary heart disease deaths were reported. Results showed that the potential mechanism may be impaired endothelial function caused by secondhand smoke exposure during childhood, resulting in the development of atherosclerosis in early life. They also showed that the underlying cellular mechanisms related to endothelial dysfunction can be oxidative stress from environmental tobacco smoke, including increased levels of glutathione peroxidase and catalase. Moreover, secondhand smoke exposure in childhood can cause dyslipidemia 9) and thrombosis, leading to cardiovascular consequences 10) .
These findings suggest that secondhand smoke exposure represents an urgent public health event, especially exposure in childhood. Thus, measures should be taken to increase awareness of the health dangers of secondhand smoke exposure and limit secondhand smoke by providing tobacco-free environments and improving compliance with relevant policies.
Conflicts of Interest
None.
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