• James M Lightwood, Pamela G Coxson, Kirsten Bibbins-Domingo, Lawrence W Williams, and Lee Goldman.
• Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA. lightwoodj@pharmacy.ucsf.edu
• Am J Prev Med. 2009 Jan 1; 36 (1): 132013-20.

BackgroundPassive smoking is a major risk factor for coronary heart disease (CHD), and existing estimates are out of date due to recent and substantial changes in the level of exposure.ObjectiveTo estimate the annual clinical burden and cost of CHD treatment attributable to passive smoking.Outcome MeasuresAnnual attributable CHD deaths, myocardial infarctions (MI), total CHD events, and the direct cost of CHD treatment.MethodsA Monte Carlo simulation estimated the CHD events and costs as a function of the prevalence of CHD risk factors, including passive-smoking prevalence and a low (1.26) and high (1.65) relative risk of CHD due to passive smoking. Estimates were calculated using the CHD Policy Model, calibrated to reproduce key CHD outcomes in the baseline Year 2000 in the U.S.ResultsAt 1999-2004 levels, passive smoking caused 21,800 (SE=2400) to 75,100 (SE=8000) CHD deaths and 38,100 (SE=4300) to 128,900 (SE=14,000) MIs annually, with a yearly CHD treatment cost of $1.8 (SE=$0.2) to $6.0 (SE=$0.7) billion. If recent trends in the reduction in the prevalence of passive smoking continue from 2000 to 2008, the burden would be reduced by approximately 25%-30%.ConclusionsPassive smoking remains a substantial clinical and economic burden in the U.S.

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