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. 2010 Feb 1;171(3):292-302.
doi: 10.1093/aje/kwp376. Epub 2010 Jan 5.

Secondhand smoke, vascular disease, and dementia incidence: findings from the cardiovascular health cognition study

Deborah E Barnes  1 , Thaddeus J Haight, Kala M Mehta, Michelle C Carlson, Lewis H Kuller, Ira B Tager
Affiliations

Secondhand smoke, vascular disease, and dementia incidence: findings from the cardiovascular health cognition study

Deborah E Barnes et al. Am J Epidemiol. .

Abstract

Recent studies have found that smoking is associated with an increased risk of dementia, but the effects of secondhand smoke (SHS) on dementia risk are not known to have previously been studied. The authors used Cox proportional hazards marginal structural models to examine the association between self-reported lifetime household SHS exposure and risk of incident dementia over 6 years among 970 US participants in the Cardiovascular Health Cognition Study (performed from 1991 to 1999) who were never smokers and were free of clinical cardiovascular disease (CVD), dementia, and mild cognitive impairment at baseline. In addition, because prior studies have found that SHS is associated with increased risk of CVD and that CVD is associated with increased risk of dementia, the authors tested for interactions between SHS and measures of clinical and subclinical CVD on dementia risk. Moderate (16-25 years) and high (>25 years) SHS exposure levels were not independently associated with dementia risk; however, subjects with >25 years of SHS exposure and >25% carotid artery stenosis had a 3-fold increase (hazard ratio = 3.00, 95% confidence interval: 1.03, 9.72) in dementia risk compared with subjects with no/low (0-15 years) SHS exposure and < or =25% carotid artery stenosis. High lifetime SHS exposure may increase the risk of dementia in elderly with undiagnosed CVD.

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Figures

Figure 1.
Figure 1.
Hypothesized causal pathways by which lifetime exposure to secondhand smoke could increase the risk of dementia—directly (solid arrow) or indirectly (dashed arrows)—by exacerbating the effects of clinical cardiovascular disease (myocardial infarction, angina, stroke/transient ischemic attack) or subclinical cardiovascular or cerebrovascular disease.
Figure 2.
Figure 2.
Association of secondhand smoke and internal carotid artery stenosis with dementia risk in the Cardiovascular Health Cognition Study, performed from 1991 to 1999. Cox proportional hazards marginal structural models were used to calculate hazard ratios for dementia as a function of secondhand smoke exposure and internal carotid artery stenosis, neither of which increased dementia risk when considered alone. However, the risk of dementia was 3 times higher for those with high levels of secondhand smoke exposure (>25 years) and internal carotid artery stenosis (>25%) compared with those with no/low secondhand smoke exposure (<15 years) and ≤25% stenosis.
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References

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