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"Ain't nobody got time for that": Where there's smoke, there's fire and calcium! . . . In your coronary arteriesMar 10, 2013 20:13 EDT
Ad nauseum. That's what comes to mind every time I learn the results of another presentation on secondhand smoke exposure. How many ways do we need to package the information so that the public demands protection? The research data presented by Dr Harvey Hecht from Mount Sinai Medical Center looked at "never smokers" who reported low, moderate, or high levels of smoke exposure and found they were "50%, 60%, and 90% more likely to have evidence of coronary artery calcification than those who reported minimal exposure." That's pretty sobering data for those of us on the outside of this issue, looking in. It's even more sobering for those who spent years living or working in a halo of smoke, viewed for centuries as a mere aggravation. In the past decade it is now generally accepted as potentially lethal.
In this study, 3000 healthy individuals aged 40 to 80 who smoked fewer than 100 cigarettes in their lifetime already enrolled in the Flight Attendant Medical Research Institute (FAMRI) International Early Lung Cancer Action Program by computed-tomography (CT) screening were studied by calcium scoring. Data were collected on the number of years of exposure, the intensity in packs per day, and whether or not there were any restrictions on smoking in their air space. People with the highest levels of exposure were more often female, diabetic, dyslipidemic, and hypertensive. "Researchers found that 26% of people exposed to varying levels of secondhand smoke had signs of coronary artery calcification compared with 18.5% of the general population" according to Dr. Hecht. . . . And then one might ask, "Why is having coronary calcium bad?"
First, common sense: the only things we should be calcifying in our bodies are our bones. Second: we have genetic tendencies that we can't avoid. Third: we do enough bad things to our bodies that we will probably calcify our coronary tree to some extent anyway, so why expose ourselves to an accelerant and have the arteries of a 90-year-old when we're 60 if we can avoid it? Fourth: numerous studies point to the increasing cardiovascular risk of patients as calcium scores increase.
Vliegenthart et al (Circulation 2005; 112:572–577) looked at a subset of elderly patients to evaluate the determinants and consequences of coronary artery calcification. A twofold increase in mortality in 1795 patients >70 years old who had CAC >100 was noted when compared with CAC ≤100. Raggi et al (Circulation 2008; 52:17–23) demonstrated a six- to 11-fold higher mortality risk among elderly individuals with increasing coronary calcification. LaMonte et al (Am J Epidemiology 2005;162:421–429) reviewed the incidence of MI-related death or nonfatal MI in an asymptomatic population compared with the degree of coronary calcium. Among patients >65 years of age, a coronary calcification score >400 was associated with a ninefold increase in the incidence of coronary events compared with those with no calcium. So I think we've firmly established that having coronary calcium isn't optimal. Conversely, we know it's fairly difficult for someone without coronary calcification to have a heart attack; not impossible, but pretty darned difficult.
As journalists and healthcare providers, we blog about smoke exposure, we read about the risks of smoke exposure, and as practitioners, we ask about it in the exam room and the hospital rooms, yet bystanders who interface with smoke at home, work, or play continue to be harmed. Their ongoing affiliation with that strange world of addiction, pleasure, and obsession is puzzling, since in recent years, smoke exposure has morphed into one of the finest examples of inconsideration and disregard for human health and life that exists the industrialized world, right behind armed assault.
The quest for protection from secondhand-smoke exposure is worth the yawn, the tirade, or the chance for meaningful conversation. Persistence pays off. For instance, the state of Kentucky is debating at this very moment whether going "smoke-free" would be good for the economy (a state that spends gazillions of dollars on preventable illness, has nearly the lowest level of education in the Union [a huge predictor of the economic health of a state], and leads the nation in lung-cancer deaths). I agree, that's a great big DUH . . . but we are more hopeful than ever. The judiciary committee decided last week that going smoke-free won't impact anyone's property rights, and we won't infract the Constitution of the United States of America by asking people to smoke (on the porch or somewhere outside) the same two packs they were going to smoke inside a public building or workplace. If we can score a victory for potential victims of secondhand smoke exposure in the "sickest" state in the Union, no one in the world should have any excuse not to.
I strongly recommend that if one can't sear the conscience of their smoking coworker, perhaps one can appeal to their state representative, city officials, or employer to petition them for the right to breathe clean air. As for inconsiderate family members, one will need to navigate that one alone. Perhaps explaining to them that "Love means never having to say you're sorry" for giving someone a lethal illness might be a good place to start. Never give up on trying to rock their smoke-filled world.
Dr Hecht made the excellent point that screening patients for coronary calcium also affords the opportunity to screen for lung cancer, emphysema, and coronary artery disease in a single low-(radiation) dose scan. Thanks to the information presented in this study, we know that secondhand smoke exposure increases coronary calcium, a known marker for coronary artery disease and a risk factor for stroke and heart attack death. In the now famous words of Chicago's latest celebrity, Sweet Brown, I completely agree.
"Ain't nobody got time for that."