Environmental tobacco smoke and measures of subclinical vascular disease.

Assessing the relationship of exposure to environmental tobacco smoke (ETS) with subclinical measures of atherosclerotic disease supplements the epidemiologic data on fatal and nonfatal cardiovascular events. In addition, such assessment offers the opportunity to study smaller populations (including subgroups within larger studies) through improved statistical precision relative to the analysis of the relationship of ETS and clinical events and provides insights into the mechanisms of the harmful effects of ETS. In this article we review the published literature on the relationship of ETS with several indices of subclinical atherosclerosis including carotid artery intimal-medial thickness, brachial artery endothelial functioning, and silent cerebral infarctions. In each of these domains, exposure to ETS is associated with evidence of increased subclinical vascular disease.