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Vascular Aging Is Accelerated in Flight Attendants With Occupational Secondhand Smoke Exposure

Wei, Janet, MD; Shufelt, Chrisandra, MD, MS; Oestreicher Stock, Eveline, MD; Mills, Claire, RDMS, RVT; Dhawan, Shivani, MS; Jacob, Riya, BASc; Torbati, Tina, BS; Cook-Wiens, Galen, MS; Benowitz, Neal, MD; Jacob, Peyton, PhD; Ganz, Peter, MD; Bairey Merz, Cathleen Noel, MD; Redberg, Rita, MD, MS

Journal of Occupational and Environmental Medicine: March 2019 - Volume 61 - Issue 3 - p 197–202
doi: 10.1097/JOM.0000000000001497

Objective: To determine whether early vascular aging may be present in flight attendants with remote in-cabin secondhand smoke (SHS) exposure.

Methods: Twenty-six flight attendants with a history of in-cabin SHS exposure prior to the airline smoking bans were recruited. Pulse wave analysis, peripheral arterial tonometry, and brachial artery reactivity testing evaluated their arterial compliance and endothelial function.

Results: Flight attendants with remote in-cabin SHS exposure have normal blood pressure, pulse wave velocity, and reactive hyperemia index, but abnormal pulse pressure, augmentation index, flow-mediated dilation, and hyperemic mean flow ratio.

Conclusion: These preliminary findings suggest that flight attendants with remote in-cabin SHS exposure have preclinical signs of accelerated vascular aging and raise new questions about the relationship between remote SHS exposure and vascular health.

Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute (Drs Wei, Shufelt, Ms Dhawan, Ms Torbati, Dr Bairey Merz); Flight Attendant Medical Research Institute (FAMRI) Bland Lane Center of Excellence on Second Hand Smoke (Dr Oestreicher Stock, Ms Jacob, Dr Benowitz, Mr Jacob, Dr Redberg); Division of Cardiology, Center of Excellence in Vascular Research at the San Francisco General Hospital (Ms Mills, Dr Ganz); Biostatistics and Bioinformatics Core (Mr Cook-Wiens), Cedars-Sinai Medical Center, Los Angeles; University of California, San Francisco Center for Tobacco Control Research and Education Tobacco Centers of Regulatory Science (TCORS) (Dr Ganz); and Division of Cardiology, Department of Medicine (Drs Oestreicher Stock, Redberg), University of California, San Francisco, San Francisco, California.

Address correspondence to: Cathleen Noel Bairey Merz, MD, 127 S. San Vicente Blvd, Suite A3206, Los Angeles, CA 90048 (

Funding Source: This work was supported by the Flight Attendant Medical Research Institute (FAMRI) and University of California, San Francisco (UCSF) Bland Lane Center of Excellence on Second Hand Smoke; the National Institute on Drug Abuse.

Conflicts of Interest: Dr. Neal Benowitz has served as an expert witness in litigation against tobacco companies.

Copyright © 2019 by the American College of Occupational and Environmental Medicine