Review ArticlesSecond-Hand Tobacco Smoke and Cardiovascular Disease Risk: An Epidemiological ReviewDunbar, Andrew MD*; Gotsis, William MD†; Frishman, William MD†Author Information From the *Department of Internal Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY, and †Department of Medicine, Division of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY. Accepted for publication October 27, 2012 The authors declare no conflict of interest William H. Frishman, MD, Department of Medicine, New York Medical College, Munger Pavillion, 263, Valhalla, NY 10595. E-mail: William_Frishman@nymc.edu Cardiology in Review: March/April 2013 - Volume 21 - Issue 2 - p 94-100 doi: 10.1097/CRD.0b013e31827362e4 Buy Metrics Abstract In this review, we have sought to examine the epidemiological, basic science, and public health data regarding the association between second-hand smoke (SHS) exposure and the development of coronary heart disease (CHD). SHS increases the risk of CHD by 25–30% according to multiple cohort, case-control, and meta-analytical studies. Physiologic and basic science research suggest that the mechanisms by which SHS affects the cardiovascular system are multiple and include increased thrombogenesis and low-density lipoprotein oxidation, decreased exercise tolerance, dysfunctional flow-mediated vasodilatation, and activation of inflammatory pathways with concomitant oxidative damage and impaired vascular repair. As a result, chronic exposure promotes atherogenesis and the development of cardiovascular disease, increasing the risk of having an acute coronary syndrome (ACS). With the implementation of statewide and nationwide public smoke-free legislation across the United States and Europe, respectively, over the last 10–15 years, there has been a significant and reciprocal decline in the incidence of emergency admissions for ACS by an average 17% despite persistent attempts on the part of the tobacco industry to diminish the correlation between SHS exposure and CHD. These findings underscore the importance of the effects of smoking legislation on community health. © 2013 Lippincott Williams & Wilkins, Inc.