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Int. J. Environ. Res. Public Health 2017, 14(5), 504; doi:10.3390/ijerph14050504

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

1
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
2
Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
3
Medstar Health Research Institute, Hyattsville, MD 20782, USA
4
Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC 20007, USA
5
Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 5 January 2017 / Revised: 20 March 2017 / Accepted: 25 April 2017 / Published: 9 May 2017
(This article belongs to the Section Environmental Health)
View Full-Text   |   Download PDF [288 KB, uploaded 11 May 2017]

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. View Full-Text
Keywords: environmental tobacco smoke; cardiovascular disease; American Indian population; dietary effect modification; prospective cohort study environmental tobacco smoke; cardiovascular disease; American Indian population; dietary effect modification; prospective cohort study
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Rajkumar, S.; Fretts, A.M.; Howard, B.V.; Yeh, F.; Clark, M.L. 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. Int. J. Environ. Res. Public Health 2017, 14, 504.

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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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