Association between secondhand smoke exposure and hypertension: nearly as large as smoking

Modifiable risk factors and risk of myocardial infarction in offspring with parental disease

AIMS

Children of patients with early-onset myocardial infarction (MI) are at increased risk, but the importance of concordant vs. discordant parent-offspring risk factor profiles on MI risk is largely unknown. We quantified the long-term absolute risk of MI according to shared risk factors in adulthood.

METHODS AND RESULTS

We sampled data on familial predisposed offspring and their parents from the Framingham Heart Study. Early MI was defined as a history of parental MI onset before age 55 in men or 65 in women. Individuals were matched 3:1 with non-predisposed offspring. Cardiovascular risk factors included obesity, smoking, hypertension, high cholesterol, and diabetes. We estimated the absolute 20-year incidence of MI using the Aalen-Johansen estimator. At age 40, the 20-year risk of MI varied by cholesterol level [high cholesterol 25.7% (95% confidence interval 11.2-40.2%) vs. non-high cholesterol 3.4% (0.5-6.4)] among predisposed individuals, and this difference was greater than in controls [high cholesterol 9.3% (1.5-17.0) vs. non-high cholesterol 2.5% (1.1-3.8)]. Similar results were observed for prevalent hypertension [26.7% (10.8-42.5) vs. 4.0% (0.9-7.1) in predisposed vs. 10.8% (3.2-18.3) and 2.1% (0.8-3.4) in controls]. Among offspring without risk factors, parental risk factors carried a residual impact on 20-year MI risk in offspring [0% (0-11.6) for 0-1 parental risk factors vs. 3.3% (0-9.8) for ≥2 parent risk factors at age 40, vs. 2.9% (0-8.4) and 8.5% (0-19.8) at age 50 years].

CONCLUSION

Children of patients with early-onset MI have low absolute risks of MI in the absence of midlife cardiovascular risk factors, especially if the parent also had a low risk factor burden prior to MI.

Hypertension-Associated Expenditures Among Privately Insured US Adults in 2021

BACKGROUND

There are no recent estimates for hypertension-associated medical expenditures. This study aims to estimate hypertension-associated incremental medical expenditures among privately insured US adults.

METHODS

We conducted a retrospective cohort study using IQVIA's Ambulatory Electronic Medical Records-US data set linked with PharMetrics Plus claims data. Among privately insured adults aged 18 to 64 years, hypertension was identified as having ≥1 diagnosis code or ≥2 blood pressure measurements of ≥140/90 mm Hg, or ≥1 antihypertensive medication in 2021. Annual total expenditures (in 2021 $US) were estimated using a generalized linear model with gamma distribution and log-link function adjusting for demographic characteristics and cooccurring conditions. Out-of-pocket expenditures were estimated using a 2-part model that included logistic and generalized linear model regression. Overlap propensity score weights from logistic regression were used to obtain a balanced sample on hypertension status.

RESULTS

Among the 393 018 adults, 156 556 (40%) were identified with hypertension. Compared with individuals without hypertension, those with hypertension had $2926 (95% CI, $2681-$3170) higher total expenditures and $328 (95% CI, $300-$355) higher out-of-pocket expenditures. Adults with hypertension had higher total inpatient ($3272 [95% CI, $1458-$5086]) and outpatient ($2189 [95% CI, $2009-$2369]) expenditures when compared with those without hypertension. Hypertension-associated incremental total expenditures were higher for women ($3242 [95% CI, $2915-$3569]) than for men ($2521 [95% CI, $2139-$2904]).

CONCLUSIONS

Among privately insured US adults, hypertension was associated with higher medical expenditures, including higher inpatient and out-of-pocket expenditures. These findings may help assess the economic value of interventions effective in preventing hypertension.

Association of health behaviors in life's essential 8 and hypertension in adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Hypertension is a common condition during adolescence with increasing prevalence globally, alongside the epidemic of unhealthy lifestyles and obesity. Health behaviors have been shown to be associated with hypertension risk in adults. Life's essential 8 (LE8), as a comprehensive indicator to evaluate cardiovascular health (CVH), includes 4 health factors and 4 health behaviors. This study aims to evaluate the association between health behaviors defined in LE8 and hypertension among adolescents.

METHODS

Data of this study were extracted from the National Health and Nutrition Examination Surveys (NHANES) 2007-2018. Health behaviors of LE8 including diet, physical activity and tobacco smoke exposure. The outcome was the odd of hypertension in adolescents. The weighted univariate and multivariate logistic regression was unitized to explore the relationship between CVH score and hypertension in adolescents. Subgroup analysis and sensitivity analysis were further conducted to explore the association across different populations.

RESULTS

Totally 3,941 adolescents aged 12-17 years were included, with the mean aged of 14.48 ± 0.04 years. Of whom, 203 (5.15%) had hypertension. After adjusted all covariates, high CVH score was associated with the lower odds of hypertension (OR = 0.32, 95%CI: 0.17-0.61), especially in boys (OR = 0.23, 95%CI: 0.11-0.51) and adolescents with overweight/obesity (OR = 0.24, 95%CI: 0.10-0.56). Sensitivity analysis reported that the association between CVH score and the odds of hypertension was also robust after excluding self-reported hypertension and medication taking (OR = 0.37, 95%CI: 0.18-0.74).

CONCLUSION

A high CVH score, indicating a greater adherence of health behaviors, was associated with a reduced odds of hypertension, especially among boys and overweight/obesity adolescents. Large-scale prospective cohort studies are needed to further explore the association between health behaviors defined in LE8 and hypertension among adolescents.

Secondhand smoke exposure among adolescents in the gulf cooperation council countries: analysis of global youth tobacco surveys

This study aimed to analyze patterns and predictors of secondhand smoke (SHS) exposure among adolescents (12-16 years old) in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Nationally representative data from the most recent Global Youth Tobacco Survey in each country were analyzed (N = 17,220). SHS exposure at home, in public places, and at school was assessed. Descriptive statistics summarized exposure prevalence overall and by sex. Multivariable logistic regression examined factors associated with each SHS exposure's outcome. The results showed that SHS exposure was high overall, with exposure at home and school ranging from 12.7 to 20.7%, respectively, in Oman to 39.4% and 36.7%, respectively, in Kuwait. Almost half of the adolescents reported exposure to SHS in public places, with a prevalence of 40.8% in Saudi Arabia to 65.9% in Kuwait. The prevalence of exposure varied between countries, with the highest rates occurring in Kuwait. Girls had higher exposure at home, while boys had higher exposure in public and at school. Factors associated with higher exposure included parental smoking, friend smoking, and tobacco advertising. The belief that SHS is harmful was associated with lower home exposure. In conclusion, adolescents in the Gulf Cooperation Council countries are exposed to concerning levels of SHS, especially in public places. These findings underscore the urgent need for stronger tobacco control policies, including comprehensive smoke-free laws covering all public venues, to protect youth from SHS exposure. Additionally, the results support the development of targeted interventions promoting smoke-free homes and social norms against smoking.

Association Between Adherence to EAT-Lancet Diet and Risk of Hypertension: An 18-Year National Cohort Study in China

OBJECTIVE

The EAT-Lancet Commission has proposed an EAT-Lancet diet (ELD), also known as a planetary health diet (PHD), which is environmentally sustainable and promotes human health. However, the association between this diet and the risk of hypertension remains unclear. This study aimed to determine whether adherence to ELD was associated with a lower risk of hypertension.

METHODS

11,402 adults without hypertension at baseline from the China Health and Nutrition Survey were included. The PHD score was used to evaluate ELD adherence, with higher scores reflecting better compliance. Cox proportional hazards regression analysis was utilized to estimate the hazard ratio (HR) with a 95% confidence interval (CI). Additionally, a subgroup analysis was performed to identify the possible effect modifiers, and a mediation analysis was conducted to explore the mediation effects of anthropometric measurements on the association between ELD and hypertension.

RESULTS

A total of 3993 participants (35%) developed hypertension during 93,058 person-years of follow-up. In the covariate-adjusted model, hypertension risk was reduced in the highest quartile participants compared to the lowest quartile of the PHD score (adjusted HR: 0.79, 95%CI: 0.71-0.87; P-trend < 0.001), which remained significant after sensitivity analysis. Notably, the association was also observed in isolated systolic hypertension, isolated diastolic hypertension, and systolic-diastolic hypertension. Subgroup analysis revealed that the inverse association between the PHD score and hypertension risk was more pronounced in nonsmokers and high-sodium intake consumers than in smokers and low-sodium consumers (P-interaction < 0.05). Additionally, mediation analysis revealed that 23.3% of the association between the PHD score and hypertension risk was mediated by the waist-to-height ratio.

CONCLUSION

Our findings suggest that a higher adherence to ELD is associated with a lower risk of hypertension. These results emphasize that ELD may serve as a potential strategy to prevent hypertension.

Risk factors of osimertinib-related cardiotoxicity in non-small cell lung cancer

Objective

To investigate the risk factors associated with cardiotoxicity in patients with non-small cell lung cancer (NSCLC) treated with osimertinib.

Methods

A total of 268 patients with NSCLC treated with osimertinib in our hospital from June 2019 to December 2023 were selected to observe the occurrence of cardiotoxicity and were divided into cardiotoxicity group and non-cardiotoxicity group. The differences in age, gender, body mass index (BMI), smoking, alcohol consumption, tumor stage, hypertension, diabetes, hyperlipidemia, chemotherapy, radiotherapy, antiangiogenic drugs, and osimertinib treatment time were recorded and analyzed. Logistic regression was used to analyze the risk factors for cardiotoxicity in patients with non-small cell lung cancer caused by osimertinib treatment.

Results

Among the 268 patients with NSCLC treated with osimertinib, 58 patients developed cardiotoxicity, and the incidence of cardiotoxicity was 21.64%. There were statistically significant differences between the cardiotoxicity group and the non-cardiotoxicity group in terms of smoking history, hyperlipidemia history, combined chemotherapy, and combined radiotherapy (P < 0.05). Further analysis showed that patients with a smoking history were at increased risk of cardiotoxicity compared with non-smoking patients (OR = 2.569, 95% CI = 1.398-6.523). Patients with hyperlipidemia were at increased risk of cardiotoxicity compared with those without hyperlipidemia (OR = 3.412, 95% CI = 2.539-7.628). Patients with chemotherapy were at increased risk of cardiotoxicity compared with those without combination chemotherapy (OR = 2.018, 95% CI = 1.426-4.517). Patients undergoing radiotherapy to the left chest were at increased risk of cardiotoxicity compared with those without combined radiotherapy (OR = 1.629, 95% CI = 1.273-4.206).

Conclusion

The incidence of cardiotoxicity in patients with NSCLC is high due to osimertinib treatment. A history of smoking, hyperlipidemia, combination chemotherapy, and radiotherapy to the left chest are independent risk factors for cardiotoxicity in patients with NSCLC treated with osimertinib.

Secondhand Smoke Exposure and Risk of Dementia in Nonsmokers: A Population-Based Cohort Study

BACKGROUND

Large population-based prospective studies are necessary to provide clarification on the associations of panoramic secondhand smoking burden, including prenatal and postnatal secondhand smoke (SHS) exposure, with the risk of developing dementia.

METHODS

Our study comprised a sample of 353,756 dementia-free individuals from the UK Biobank who were nonsmokers had data on the exposure of maternal smoking as well as SHS exposure in daily life, which was quantified in terms of hours per week (h/week) and whether they lived with household smokers. Multivariable Cox regression models were utilized to analyze the independent and joint associations of maternal smoking and daily life SHS exposure with dementia risk.

RESULTS

During a median follow-up of 11.8 years, 4,113 participants developed dementia. Compared with those who lived in the environment without smokers, multivariable-adjusted hazard ratios (HRs) (95% CIs) were 1.11 (1.02, 1.20) and 1.31 (1.13, 1.52) for those who exposed to SHS for >0 but ≤4 h/week and >4 h/week, respectively, and was 1.25 (1.13, 1.39) for those who lived with smokers in the household. A positive history of maternal smoking was associated with a modestly higher risk of dementia (HR = 1.07; 95% CI: 1.01, 1.15). Furthermore, compared with participants with neither history of maternal smoking nor exposure to SHS, a particularly higher risk of dementia was observed among those with both exposures (HR = 1.48; 95% CI: 1.18, 1.86). Additionally, the HR (95% CI) was 1.32 (1.10, 1.59) when comparing participants with a history of maternal smoking who lived with smokers in their households with those who had neither exposures.

CONCLUSIONS

Having a history of maternal smoking, longer exposure to SHS, and living with smokers in the household were each associated with an increased risk of developing dementia. Individuals who were simultaneously exposed to maternal smoking and SHS or lived with household smokers had a particularly higher dementia risk.

Cardiovascular disease and lung cancer

Lung cancer is the second most common cancer worldwide and the leading cause of cancer-related death. While survival rates have improved with advancements in cancer therapeutics, additional health challenges have surfaced. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with lung cancer. CVD and lung cancer share many risk factors, such as smoking, hypertension, diabetes, advanced age, and obesity. Optimal management of this patient population requires a full understanding of the potential cardiovascular (CV) complications of lung cancer treatment. This review outlines the common shared risk factors, the spectrum of cardiotoxicities associated with lung cancer therapeutics, and prevention and management of short- and long-term CVD in patients with non-small cell (NSCLC) and small cell (SCLC) lung cancer. Due to the medical complexity of these patients, multidisciplinary collaborative care among oncologists, cardiologists, primary care physicians, and other providers is essential.

Comparison of data-driven identified hypertension-protective dietary patterns among Chinese adults: based on a nationwide study

PURPOSE

Diet pattern (DP) is a key modifiable and cost-effective factor in hypertension (HTN) management. The current study aimed to identify and compare the hypertension-protective DPs among Chinese adults.

METHODS

52,648 participants aged over 18 years were included from China Nutrition and Health Surveillance (CNHS) 2015-2017. Reduced rank regression (RRR) and partial least square regression (PLS) was applied to identify the DPs. Multivariable-adjusted logistic regression was used to assess the association between the DPs and HTN.

RESULTS

DPs derived by RRR and PLS were both featured by higher consumption of fresh vegetables and fruits, mushrooms and edible fungi, seaweeds, soybeans and related products, mixed legumes, dairy products, fresh eggs, and lower of refined grain consumption. Compared to the lowest quintile, participants in the highest quintile had lower odds of HTN (RRR-DP: OR = 0.77, 95% CI = 0.72-0.83; PLS-DP: OR = 0.76, 95% CI = 0.71-0.82; all p < 0.0001). Simplified DP scores were observed the same protective tendencies (Simplified RRR-DP: OR = 0.81, 95% CI = 0.75-0.87; Simplified PLS-DP: OR = 0.79, 95% CI = 0.74-0.85; all p < 0.0001) and showed effective extrapolation in subgroups defined by gender, age, location, lifestyle, and different metabolic conditions.

CONCLUSIONS

The identified DPs had high conformity with East Asian dietary habits, and significantly negative associations with HTN among Chinese adults. The simplified DP technique also indicated the potential for improving the extrapolation of the results of DP analysis related to HTN.

Joint effect of overweight/obesity and tobacco exposure on hypertension in children aged 6-17 years: a cross-sectional study

Aim

To assess the individual effects of overweight/obesity and tobacco exposure, and their combined effects on hypertension in children.

Methods

This cross-sectional study included 6,339 children aged 6-17 years from National Health and Nutrition Examination Surveys 1999-2018. Participants' height, weight and blood pressure (BP) were measured by trained technicians. Hypertension was defined as: mean systolic BP (SBP) and/or diastolic BP (DBP) ≥ 90th percentile for sex, age, and height (for children aged 1-13 years), and SBP ≥120 mmHg and/or a DBP ≥80 mmHg (for adolescents aged 13-17 years); or self-reported having been diagnosed with hypertension or taking antihypertensive medication. Gender- and age-specific body mass index (BMI) cut-points were used to define overweight/obesity: "overweight" was defined as a BMI > 1 standard deviation (SD); "obesity" was defined as BMI > 2SD; and "thinness" was defined as BMI < -2SD. Tobacco exposure was defined as having serum cotinine levels >0.05 µg/L or reporting the presence of at least one smoker in the household. Weighted univariate and multivariate logistic regression models were used to assess overweight/obesity and tobacco exposure with the odds of hypertension, and the combined effects of overweight/ obesity and tobacco exposure on hypertension, followed by strata-specific analyses. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results

The prevalence of overweight/obesity and tobacco exposure was significantly higher in the hypertension group than in the non-hypertension group. Overweight/obesity (OR = 1.67, 95%CI: 1.26-2.21/ OR = 2.38, 95%CI: 1.67-3.39) and tobacco exposure (OR = 1.58, 95%CI: 1.16-2.14) were associated with a higher odd of hypertension in children, respectively. Additionally, we also observed the combined effect between overweight (OR = 3.05, 95%CI: 1.96-4.75)/obesity (OR = 3.68, 95%CI: 2.24-6.03) and tobacco exposure were related to hypertension odds in children, with a significant effect in different populations.

Conclusion

There may exist joint effect of overweight/obesity and tobacco exposure on the odds of hypertension in American children. These findings offer an insight that early weight control and reduction of tobacco exposure may be important to reduce odds of hypertension in children.

CYP2C19 loss-of-function is associated with increased risk of hypertension in a Hakka population: a case-control study

BACKGROUND

Genetic factors have a certain proportion in the risk factors of hypertension. The purpose was to investigate the relationship of cytochrome P450 2C19 (CYP2C19) polymorphisms with hypertension in Hakka population.

METHODS

The study included 1,872 hypertensive patients and 1,110 controls. The genotypes of CYP2C19 rs4244285 and rs4986893 of all individuals were detected and analyzed.

RESULTS

The genotype and allele distributions of CYP2C19 rs4244285 were significantly different between hypertension group and control group. The CYP2C19 *1/*1 genotype was the most predominant among the subjects (40.8%), followed by the CYP2C19 *1/*2 genotype (40.5%). The percentage of CYP2C19*1, *2, and *3 allele was 64.2%, 30.8%, and 5.0%, respectively. The proportion of intermediate metabolizers (IM) (49.3% vs. 42.9%), poor metabolizers (PM) (14.3% vs. 8.9%) (P < 0.001), and CYP2C19*2 allele (33.8% vs. 25.7%, P < 0.001) in hypertension group was significantly higher than that in control group. Multivariate logistic regression (adjusted for gender, age, smoking, and drinking) indicated that CYP2C19 *1/*2, *1/*3, and *2/*2 genotypes may increase susceptibility to hypertension. And the CYP2C19 IM genotype (IM vs. EM: OR 1.514, 95% CI: 1.291-1.775, P < 0.001), PM genotype (PM vs. EM: OR 2.120, 95% CI: 1.638-2.743, P < 0.001), IM + PM genotypes (IM + PM vs. EM: OR 1.617, 95% CI: 1.390-1.882, P < 0.001) may increase risk of hypertension.

CONCLUSIONS

CYP2C19 loss-of-function (IM, PM genotypes) is independent risk factor for hypertension susceptibility. Specifically, the risk genotypes include CYP2C19 *1/*2, *1/*3, and *2/*2.

Smoking and environmental tobacco smoke exposure: implications in ocular disorders

PURPOSE

This article aims to gather and review the available knowledge on several implications of smoking and environmental tobacco smoke (ETS) exposure in ocular disorders and provides pathomechanistic insights where applicable.

MATERIALS AND METHODS

PubMed and Scopus databases were searched for relevant studies on the association of smoking and ETS exposure with various ocular disorders. Studies with different evidence levels, e.g., in-vivo, case-control, cohort, and meta-analysis, were included.

RESULTS

Smoking is an established, modifiable risk factor in several ocular diseases, including cataract, age-related macular degeneration, and Graves' ophthalmopathy; smokers are subject to more severe disease courses and less favorable treatment outcomes. Uveitis is twice as likely in smokers; smoking may also delay its resolution. Smoking and ETS exposure are major risk factors for diseases of other organs, with associated ocular complications as well, such as diabetes mellitus. ETS exposure is also associated with ocular surface pathologies, including dry eye syndrome. In children, early-life ETS exposure and maternal smoking during pregnancy are strongly associated with refractive errors and strabismus. Currently, available data on potential risks attributable to ETS exposure regarding ocular diseases are scarce and, in some instances, controversial.

CONCLUSION

In addition to smoking, ETS exposure is also a significant public health concern with possible links to several ocular diseases. However, the level of education of at-risk populations in this regard does not match the strength of the evidence.

Smoke Exposure Reduces the Protective Effect of Physical Activity on Hypertension: Evidence from the National Health and Nutrition Examination Survey (NHANES) 2013-2018

The joint effects between smoke exposure (SE) and physical activity (PA) on hypertension are still unclear, and the effect of SE is still debated. To explore associations and joint effects of SE and PA on hypertension, the data of 14,456 selected participants from the NHANES (2013-2018) were used for analyses. SE status was divided by serum cotinine concentrations. Moderate-to-vigorous intensity PA (MVPA) and insufficient or no PA (INPA) were divided by the Global Physical Activity Questionnaire. Hypertension was assessed by blood pressure and questionnaires. Survey logistic multivariable regression models were conducted for data analyses. In fully adjusted models, hypertension risk among SE participants increased (OR = 1.175, 95% CI: 1.036-1.332), especially those who were <40 years or female. However, the risk among MVPA participants decreased (OR = 0.747, 95% CI: 0.663-0.841), especially those who were ≥40 years. Additionally, the OR for MVPA participants without SE when compared with INPA ones without SE was 0.740 (95% CI: 0.654-0.837), especially those who were <60 years. However, the OR for MVPA participants with SE was 0.880 (95% CI: 0.747-1.037). For INPA participants, we did not observe significant ORs for SE compared with non-SE participants (p > 0.150). In conclusion, SE increased the risk of hypertension and MVPA reduced it, but SE could reduce such protective effect.

Cardiovascular diseases and ageing in India: A propensity score matching analysis of the effects of various risk factors

Cardiovascular diseases (CVDs) are one of the major causes of mortality and morbidity worldwide, with a significant burden, especially on older adults. This analysis aims to estimate the exclusive effects of various risk factors of CVDs among 59,073 older adults aged 45 years and above in India. Using data from wave 1 of the Longitudinal Ageing Study in India (LASI), the exposure effects of various risk factors on CVDs are estimated through propensity score matching. This analysis is further extended to different components of CVDs, such as hypertension, heart disease, and stroke. Results indicate that risk factors groups such as environmental, behavioral, physiological, and genetic risk factors have a positive and significant impact on CVDs. In the case of independent risk factor effects, diabetes has the highest effect on CVDs, followed by overweight, cholesterol, family history, alcohol consumption, and depression. We conclude that physiological risk factors among older adults are more severe than other factors.

Association of Different Combinations of ALDH2 rs671, APOE rs429358, rs7412 Polymorphisms with Hypertension in Middle-Aged and Elderly People: A Case-Control Study

Background

Hypertensive patients have a younger trend, and studies on the role of genetic factors in hypertension susceptibility have been inconsistent. Aldehyde dehydrogenases 2 (ALDH2) and apolipoprotein E (APOE) are involved in the pathophysiological processes of hypertension. To investigate the relationship of ALDH2 and APOE polymorphisms with hypertension in middle-aged (30-59 years old) and elderly (≥60 years old) persons.

Methods

Two thousand six hundred and ten hypertensive patients and 1921 controls were included (between 30 and 100 years old). The genotypes of common polymorphisms in APOE and ALDH2 genes (APOE rs429358, rs7412, and ALDH2 rs671) of the subjects were analyzed by polymerase-chain reaction (PCR)-microarray. Statistical analyses (Student's t-test, Mann-Whitney U-test, χ ² test, and logistic regression analysis) were performed with SPSS v21.0.

Results

There were 4531 participants (66.60 ± 12.10 years old) in this study, including 3057 (67.5%) males and 1474 (32.5%) females. There were no significant differences in distributions of ALDH2 rs671, APOE rs429358/rs7412 genotypes and alleles between hypertensive patients and controls. Persons with ALDH2 rs671 G/A or A/A genotype were less likely to have hypertension (G/A+A/A vs G/G: gender-, age-, smoking-, and drinking-adjusted OR 0.885, 95% CI 0.785-0.997, P=0.045), while ALDH2 rs671 A/A+APOE rs429358 or rs7412 wild-type genotype may decrease the risk of hypertension. In middle-aged group, ALDH2 rs671 G/A+APOE rs429358 T/C carriers (adjusted OR 0.547, 95% CI 0.350-0.856, P=0.008), and ALDH2 rs671 A/A+APOE rs7412 C/C genotypes (adjusted OR 0.567, 95% CI 0.361-0.891, P=0.014) were less likely to have hypertension. In elderly group, APOE rs7412 T/T carriers were more likely to have hypertension (rs671 T/T vs C/C: adjusted OR 4.755, 95% CI 1.075-21.027, P=0.040; rs671 T/T vs C/C or C/T: adjusted OR 4.734, 95% CI 1.071-20.928, P=0.040).

Conclusion

Polymorphism-polymorphism interactions of ALDH2 rs671 and APOE rs429358/rs7412 may effect on hypertension susceptibility. Different genotypes comparison shows different roles in middle-aged and elderly people, respectively.

Environmental Tobacco Smoke Exposure Estimated Using the SHSES Scale, and Feature Tracking Computed Tomography-Derived Left Ventricular Global Longitudinal Strain in Hypertensive Patients

Aim of the study was to assess the relationship between environmental tobacco smoke (ETS) and computed tomography-derived left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension. 103 non-smokers with AH were included in the study (age 67.73 ± 8.84 years). ETS exposure was assessed with the Second-Hand Smoke Exposure Scale (SHSES). LV GLS was measured on computed tomography using feature tracking technology. In accordance with SHSES scale patients were divided into subgroups: subgroup A—no ETS exposure, subgroup B—low ETS exposure, subgroup C—medium ETS exposure, and subgroup D—high ETS exposure. Peak of LV GLS was statistically significantly lower in subgroup D than in subgroup A. There was a negative correlation between the exposure to ETS expressed by the SHSES scale and peak of LV GLS (r = − 0.35, p < 0.05). Regression analysis showed that higher SHSES score, higher age, left ventricular hypertrophy, left ventricular diastolic dysfunction, and higher CAD-RADS are independent risk factors for lower peak of LV GLS values. On the contrary, the effective blood pressure control appeared to be independent protecting factor against lower peak of LV GLS values. In summary, there is an unfavorable weak relationship between ETS exposure estimated using the SHSES scale and LV GLS in hypertensive patients.

Association of secondhand smoke exposure with cardiometabolic health in never-smoking adult cancer survivors: a population-based cross-sectional study

BACKGROUND

Little is known about the association of secondhand smoke (SHS) exposure with cardiometabolic health in adult cancer survivors, especially those who have never smoked. This study aimed to investigate the association of SHS exposure and cardiometabolic health in never-smoking adult cancer survivors.

METHODS

Cross-sectional data of 830 adult cancer survivors aged more than 19 years who were never-smokers were identified from the Korea National Health and Nutrition Survey (KNHANES) 2013-2018, a nationally representative sample of the noninstitutionalized Korean population. SHS exposure was defined from self-reported survey and cardiometabolic outcomes (hypertension, general and abdominal obesity, hyperlipidemia, hypertriglyceridemia, reduced high-density lipoprotein, and impaired fasting glucose) were determined according to relevant criteria and data from the KNHANES. We used multiple logistic regression to compute odds ratio (OR) and 95% confidence intervals (95% CI) comparing those with and without SHS exposure for each outcome adjusted for potential confounders.

RESULTS

Compared with the never-smoking adult cancer survivors without SHS exposure, those with SHS exposure had significantly higher odds for hypertriglyceridemia (OR = 1.63; 95% CI: 1.07-2.48). However, the other outcomes showed nonsignificant associations with SHS exposure (hypertension [OR = 1.33; 95% CI: 0.90-1.96]. general obesity [OR = 1.47; 95% CI: 1.47: 0.97-2.22], abdominal obesity [OR = 1.20; 95% CI: 0.82-1.75], hyperlipidemia [OR = 1.03; 95% CI: 0.68-1.55], reduced HDL-cholesterol [OR = 1.01; 95% CI: 0.70-1.45], and impaired fasting glucose [OR = 1.07; 95% CI: 0.72-1.58].

CONCLUSION

This cross-sectional study suggests the association of SHS exposure with hypertriglyceridemia and provides evidence for marginal associations with other cardiometabolic risk factors in never-smoking adult cancer survivors. More studies are needed to develop evidence-based public health policies to minimize SHS exposure in adult cancer survivors.

Joint effect of 25-hydroxyvitamin D and secondhand smoke exposure on hypertension in non-smoking women of childbearing age: NHANES 2007-2014

BACKGROUND

Vitamin D deficiency (VDD) may increase the risk of hypertension in women of childbearing age, who may be exposed to secondhand smoke (SHS) simultaneously. Till now, few studies have investigated the joint effects of VDD and SHS on hypertension in this population. We evaluated whether exposure to SHS modified the association between VDD and hypertension.

METHODS

Data from National Health and Nutrition Examination Surveys (NHANES) 2007-2014 were analyzed. Our research subjects were 2826 nonsmoking and nonpregnant women of childbearing age (20-44 years old). Hypertension was defined based either on systolic blood pressure (SBP) ≥ 130 mmHg and/or diastolic blood pressure (DBP) ≥ 80 mmHg or on now taking prescribed medicine for hypertension. The directed acyclic graphs (DAG) and the back-door criterion were used to select a minimal sufficient adjustment set of variables (MSAs) that would identify the unconfounded effect of 25(OH)D and hypertension. The interactive effect of VDD and SHS on hypertension was evaluated by using logistic regression models, followed by strata-specific analyses.

RESULTS

The prevalence of VDD in the hypertension group was significantly higher than that in the non-hypertension group (48.2% vs 41.0%, P = 0.008), as well as the exposure rate of SHS (39.1% vs 33.8%, P = 0.017). VDD was independently associated with nearly 50% increased risk of hypertension [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI): 1.01, 2.04], while no significant association was observed between SHS and hypertension. However, SHS showed a significant synergistic effect on VDD with a higher aOR of 1.79 (95% CI: 1.14, 2.80) (P_interaction = 0.011). This synergistic effect was more obvious when stratified by BMI (in overweight women, aOR, 95% CI =4.74, 1.65-13.60 for interaction vs 2.33, 1.01-5.38 for VDD only) and race (in Non-Hispanic Black women, aOR, 95% CI =5.11, 1.58-16.54 for interaction vs 2.69, 1.10-6.62 for VDD only).

CONCLUSION

There exist synergistic effects of SHS and VDD on the prevalence of hypertension in American women of childbearing age, with more significant effects in women who were overweight or Non-Hispanic Black. Further studies are warranted to verify this finding in other populations, and the molecular mechanisms underlying the joint effect of SHS and VDD need to be elucidated.

Secondhand Smoke Exposure Impairs Ion Channel Function and Contractility of Mesenteric Arteries

Cigarette smoke, including secondhand smoke (SHS), has significant detrimental vascular effects, but its effects on myogenic tone of small resistance arteries and the underlying mechanisms are understudied. Although it is apparent that SHS contributes to endothelial dysfunction, much less is known about how this toxicant alters arterial myocyte contraction, leading to alterations in myogenic tone. The study's goal is to determine the effects of SHS on mesenteric arterial myocyte contractility and excitability. C57BL/6J male mice were randomly assigned to either filtered air (FA) or SHS (6 h/d, 5 d/wk) exposed groups for a 4, 8, or 12-weeks period. Third and fourth-order mesenteric arteries and arterial myocytes were acutely isolated and evaluated with pressure myography and patch clamp electrophysiology, respectively. Myogenic tone was found to be elevated in mesenteric arteries from mice exposed to SHS for 12 wk but not for 4 or 8 wk. These results were correlated with an increase in L-type Ca2+ channel activity in mesenteric arterial myocytes after 12 wk of SHS exposure. Moreover, 12 wk SHS exposed arterial myocytes have reduced total potassium channel current density, which correlates with a depolarized membrane potential (Vm). These results suggest that SHS exposure induces alterations in key ionic conductances that modulate arterial myocyte contractility and myogenic tone. Thus, chronic exposure to an environmentally relevant concentration of SHS impairs mesenteric arterial myocyte electrophysiology and myogenic tone, which may contribute to increased blood pressure and risks of developing vascular complications due to passive exposure to cigarette smoke.

Aortic Valve Calcification Score in Patients with Arterial Hypertension Environmentally Exposed to Tobacco Smoke

The objective of our study was to determine the relationship between exposure to environmental tobacco smoke (ETS) and the value of the aortic valve calcification score (AVCS) in people suffering from arterial hypertension (AH). 107 non-smokers with AH (mean age 67.16 ± 8.48 years) were qualified for the study. The degree of exposure to ETS was assessed using the Second-hand Smoke Exposure Scale (SHSES) questionnaire. Study group was divided depending on ETS exposure: A—no exposure, B—low, C—medium and D—high. AVCS was measured based on the aortic valve plane multiplanar reconstruction from the non-contrast phase of the cardiac computed tomography. The Agatston algorithm was used, in which calcifications were considered changes with a density exceeding 130 HU. The mean AVCS value in the study group of patients was 213.59 ± 304.86. The AVCS was significantly lower in subgroup A than in subgroups C and D. In subgroup A, the lack of aortic valve calcification (AVCS = 0) was observed significantly more frequently than in subgroups C and D. There was a positive correlation between the number of SHSES points and the AVCS value (r = 0.37, p < 0.05). Based on the ROC curve, the SHSES value was determined as the optimal cut-off point for the prediction of AVCS = 0, amounting to 3 points. The accuracy of SHSES < 3 as the predictor of AVCS = 0 was set at 62.18%. Hypertensive patients have an unfavourable relationship between the amount of exposure to ETS, determined on the SHSES scale, and the AVCS value.

Relationship between childhood secondhand smoke exposure and the occurrence of hyperlipidaemia and coronary heart disease among Chinese non-smoking women: a cross-sectional study

OBJECTIVE

The objective of this study was to evaluate the influence of secondhand smoke (SHS) exposure during childhood on type 2 diabetes mellitus, hypertension, hyperlipidaemia and coronary heart disease among Chinese non-smoking women.

METHODS

In this cross-sectional study, the SHS exposure data in childhood were obtained using a questionnaire survey. Self-reported childhood SHS exposure was defined as the presence of at least one parent who smoked during childhood.

RESULTS

Of the 6522 eligible participants, 2120 Chinese women who had never smoked were assessed. The prevalence of SHS exposure in the entire population was 28.1% (596). SHS exposure during childhood was not significant for the standard risk factors of type 2 diabetes mellitus (p=0.628) and hypertension (p=0.691). However, SHS was positively associated with hyperlipidaemia (p=0.037) after adjusting for age, obesity, education status, physical activity, alcohol consumption, current SHS exposure status, diabetes mellitus and hypertension. In addition, childhood SHS increased the occurrence of coronary heart disease (p=0.045) among non-smokers after further adjusting for hyperlipidaemia.

CONCLUSION

SHS exposure during childhood is associated with prevalent hyperlipidaemia and coronary heart disease in adulthood among non-smoking Chinese women.

Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey

INTRODUCTION

Serum cotinine is a sensitive and specific biomarker for tobacco exposure including second-hand smoke exposure (SHS). We sought to examine whether SHS is associated with heart failure (HF) among non-hospitalized adults.

METHODS

This analysis included 11 219 non-smokers (age 48.4 ± 20.5 years, 55.9% women, 70.5% whites) from the United States Third National Health and Nutrition Examination (NHANES) years 1988-1994. SHS was defined as serum cotinine ≥1 ng/mL. To assess dose-response, cut-points of serum cotinine ≥3 ng/mL and ≥6 ng/mL were used. Multivariable logistic regression was used to examine the association between SHS and HF. The consistency of this association was tested among subgroups stratified by race, gender, and comorbidities. NHANES years 2003-2006 were examined for longitudinal comparison.

RESULTS

18.9% (n = 2125) of participants had SHS exposure while 3.7% (n = 416) had HF. After adjusting for covariates, SHS was associated with a 35% increased odds of HF with a dose-response relationship between levels of serum cotinine and HF. This association was stronger in males than females (interaction p-value = 0.03) and those with a history of CVD versus those without (interaction p-value < 0.001). This association persisted in the NHANES 2003-2006 analysis.

CONCLUSION

There is a dose-response relationship between SHS and HF with possible effect modification by gender and prior CVD. This is a novel finding that underscores the harmful effects of passive smoking on the cardiovascular system and highlights the needs for further prohibition of smoking in public areas and a personalized risk assessment among high-risk groups, especially in regions with less-stringent public health policies.

IMPLICATIONS

This study showed a novel association between secondhand smoke exposure and prevalent heart failure among non-smokers, adding to the list of harmful cardiovascular manifestations of secondhand smoke exposure. This was more apparent in men and those with a prior history of cardiovascular disease. Heart failure is a debilitating disease process, so this finding has important policy implications in low-income countries and poor communities with less-stringent health policies because they are known to have the highest levels of exposure. Smoke-free policies targeting these regions would thus yield substantial public health benefits.

Exposure to secondhand smoke is associated with increased left ventricular mass

INTRODUCTION

Chronic hypertension is associated with left ventricular hypertrophy. Recent evidence suggests that secondhand smoke (SHS) exposure is associated with chronic hypertension, so we sought to examine the relationship between secondhand smoke exposure and electrocardiographic left ventricular (LV) mass among non-smokers.

METHODS

This analysis included 4982 non-smoker participants from the Third National Health and Nutrition Examination (NHANES-III). Non-smoking was defined by self-report and serum cotinine ≤10 ng/mL, a biomarker for tobacco exposure. SHS exposure was defined as serum cotinine level ≥1 ng/mL. LV mass was estimated using an electrocardiographic model developed and applied in NHANES-III then validated in the Cardiovascular Health Study. Multivariable linear regression was used to examine the cross-sectional association between SHS exposure (vs no exposure) with estimated LV mass index. In similar models, we also examined the associations of LV mass index across quartiles of serum cotinine (reference group, 1st quartile) and in subgroups stratified by age, race, sex, hypertension, and obesity.

RESULTS

About 9.8% (n=489) of the participants were exposed to SHS. Exposure to SHS was associated with an estimated 2.9 g/m² increase in LV mass index, with a dose-response relationship between higher serum cotinine and LV mass index. These results were consistent in men and women, Whites and non-Whites, elderly and non-elderly, and those with and without hypertension. Significant effect modification was present among obese individuals with an estimated 4.8 g/m² increase in LV mass index (interaction p=0.01).

CONCLUSIONS

In a racially diverse sample of non-smokers, SHS is associated with increased LV mass with a dose-response relationship between level of exposure and LV mass. Effect modification was present among obese individuals. These findings underscore the harmful effect of passive smoking on the cardiovascular system and highlight the need for more restrictions on smoking in public areas, especially in countries or regions with less-stringent public health policies.