The Relationship between Environmental Tobacco Smoke Exposure and Cardiovascular Disease and the Potential Modifying Effect of Diet in a Prospective Cohort among American Indians: The Strong Heart Study

Sarah Rajkumar, Amanda M. Fretts, Barbara V. Howard, Fawn Yeh and Maggie L. Clark
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Sarah Rajkumar: Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
Amanda M. Fretts: Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
Barbara V. Howard: Medstar Health Research Institute, Hyattsville, MD 20782, USA
Fawn Yeh: Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA
Maggie L. Clark: Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA

IJERPH, 2017, vol. 14, issue 5, 1-11

Abstract: American Indians experience high rates of cardiovascular diseases (CVD). Environmental tobacco smoke (ETS) has been linked to CVD, possibly due to pro-inflammatory and oxidative stress pathways. We examined the relationship between self-reported exposure to ETS and fatal and nonfatal CVD incidence using Cox proportional hazards models among 1843 non-smoking American Indians participating in the Strong Heart Study. We also evaluated potential modifying effects of several dietary nutrients high in anti-inflammatory and anti-oxidant properties with ETS exposure on fatal and nonfatal CVD by creating interaction terms between ETS exposure and the dietary variable. Participants exposed to ETS had a higher hazard (hazard ratio: 1.22; 95% confidence interval, 1.03 to 1.44) for developing CVD compared to persons not exposed. Interaction analyses suggested stronger effects of ETS on CVD incidence among those consuming diets lower in vitamin E as compared to those consuming higher amounts, particularly on the additive scale. Additional research is recommended to clarify whether public health prevention strategies should simultaneously target reductions in ETS exposures and improvements in diets that may exceed the expected benefits of targeting these risk factors separately.

Keywords: environmental tobacco smoke; cardiovascular disease; American Indian population; dietary effect modification; prospective cohort study (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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