Please login or register to print this page.

Clinical Articles, Lead Article

Risk of arrhythmia and stroke increased by passive smoking

Research published recently by the Institute of Medicine of the National Academies[1] reinforces the causal link between passive exposure to cigarette smoke and coronary disease. A recent report on Secondhand Smoke Exposure and Cardiovascular Effects, commissioned by the Center for Disease Control (CDC), compiles and examines the body of evidence which now exists to support the connection.

Of the various dangers posed by cigarette smoke to public health, amongst the most pertinent to stroke is the impact of smoking on the autonomic nervous system, according to the report. The research cited[2] shows that nicotine, by activating the sympathetic nervous system and triggering the release of epinephrine, directly stimulates the increased heart rate, higher blood pressure, and blood vessel constriction which can lead to arrhythmia (p.63-64).

The impact of inhaling smoke second hand is shown by the results of a study[3] which examined 1,218 nonsmokers, aged 50 and over, who participated in the Swiss Cohort Study on Air Pollution and Lung Disease in Adults (2001-2003). Those exposed to secondhand smoke for more than 2 hours a day had lower heart-rate variability and a 2.7% higher heart rate (95% CI, -0.01 to 5.34%) than those not exposed.

The capacity of second-hand smoke to increase the danger of stroke in those susceptible is the subject of a mounting scientific consensus. In 2006 the American Heart Association’s guidelines for the prevention of stroke[4], as well as highlighting smoking itself as a high risk factor, cited “growing evidence that exposure to environmental tobacco smoke (or passive smoke) increases the risk of cardiovascular disease, including stroke” (p.583).

The document identified the damaging effects of smoking as involving changes in blood dynamics and vascular stenosis. Asserting that the impact of secondhand smoke constitutes a considerable danger in its own right, the guidelines insist that “exposure to environmental smoke needs consideration in overall risk assessment”.

The CDC-commissioned report takes full advantage of hindsight, surveying the results of the widespread and increasingly severe restrictions placed on smoking in Europe and the United States over the last decade. The committee has compiled numerous studies which correlate a reduction in local hospital admissions for acute coronary events with the enforcement of anti-smoking legislation in various locations.

The text also provides a comprehensive history of the past research which has informed this debate, drawing on the body of evidence it has provided to echo and amplify the scientific consensus that there exists a causal link between secondhand smoke inhalation and cardiovascular disease.


  1. Goldman et al, Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence, Goldman et al, (The National Academies Press, 2010)
  2. Haass, M., and W. Kubler. 1997. Nicotine and sympathetic neurotransmission (Cardiovascular Drugs and Therapy 10(6):657-665, 1997)
  3. Dietrich, D. F., et al, Effects of passive smoking on heart rate variability, heart rate and blood pressure: An observational study (International Journal of Epidemiology 26(4):834-840, 2007)
  4. Sacco et al, Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke (Stroke;37;577-617, 2006)

Published on: January 13, 2011

Members Area

Log in or Register now.

 For healthcare professionals only
Learning sky



Subscribe to our RSS feed


Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.


    None Found


  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.