Toddlers Affected Most by Secondhand Smoke
Exposure at Home
Secondhand smoke in the
home appears to induce markers for heart disease as
early as the toddler years, researchers reported at the
American Heart Association's 48th Annual Conference on
Cardiovascular Disease Epidemiology and Prevention.
It has long been known that many forms of cardiovascular
disease in adults are initiated and progress silently during
childhood. Now researchers have found a young child's response
to smoke may not just affect the respiratory system, but
the cardiovascular system as well.
"This is the first study that looks at the response of a young
child's cardiovascular system to secondhand smoke," said
Judith Groner, M.D., lead
author of the study, pediatrician and ambulatory care
physician at Nationwide Children's Hospital and Research
Institute in Columbus, Ohio.
The study included 128 children, 2 to 5 years old and
adolescents 9 to 14. Researchers found that children ages
2 to 5 absorbed six times more nicotine than children 9
to 14 from the same levels of parental smoking. That exposure
resulted in a dramatic increase of markers of
inflammation and vascular injury signaling damage to the
endothelium, the inner lining of the vessel walls.
Hair samples of children ages 2 to 5 showed this age group had
average nicotine levels of 12.68 nanograms per milligram of
hair compared to the 9 to 14 year age group, which had 2.57
nanograms per milligram of hair. Toddlers had significantly
higher levels of the inflammatory marker soluble
intracellular adhesion molecules (ICAM). "Toddlers in the
homes of smokers not only had higher levels of nicotine, but
also had higher levels of markers for cardiovascular disease
in the blood," said John Bauer, Ph.D., senior author of
the study and director of the Center for Cardiovascular
Medicine at Nationwide Children's Hospital and Research
Institute in Columbus, Ohio. "The dose of smoke is greater in
toddlers than adolescents who are able to move in and out of
the home. Toddlers are like a fish in a fishbowl. They are
exposed at a higher dose. And it appears that toddlers also
are more susceptible to the cardiovascular effects of smoke."
Most of the children in the study had varying levels of
secondhand smoke exposure, measured by the number of adult
smokers a child was exposed to in 24 hours. Researchers took
hair samples to determine nicotine levels in the body and drew
blood to determine endothelial progenitor cell (EPC) levels by
flow cytometry. Endothelial progenitor cells replenish the
endothelium and serve as a biological marker for vascular
Researchers also measured known inflammatory markers, such as
ICAM, in the blood.
"When we analyzed our data by looking at the relationships
between the number of smokers in the home and the EPC levels,
we found that in toddlers, there was an inverse relationship
between secondhand smoke exposure and EPC prevalence," Groner
said. "In other words, the more smokers the toddler was
exposed to, the fewer EPC cells were circulating in his
bloodstream. This relationship was not present among the
The vascular endothelium (the inner lining of arteries and
blood vessels) plays a key role in promoting cardiovascular
health by maintaining the tone
and circulation of the arteries. ICAM is a specific marker of
endothelial cell stress, which contributes to artery clogging
and atherosclerosis, raising the risk of heart disease.
"The combustion of the cigarettes appears to be causing
endothelial damage which is reflected in the increase in
soluble ICAM in exposed children,"
Groner said. "Toddlers who are in the vicinity of smokers in
the home have a higher dose of tobacco chemicals. They live at
home and can't escape. Young children also breathe faster,
taking more smoke into their respiratory system."
Past studies found that the levels of EPC are lower in adult
smokers. EPCs have not been studied previously in non-smokers
who are exposed to
This study indicates that cardiovascular effects of tobacco
exposure in children is very similar to that of adults in the
affect on the vascular
wall, Groner said.
She noted the study is a "snapshot in time" and doesn't give a
long-term picture of the effects of secondhand smoke on the
system of children.
"The results are intriguing, but further study is needed," she
said. "We're not sure what happens to kids if they stay in a
smoking environment or if
they have multiple risk factors such as being overweight or
having high blood pressure. Until then, parents and others
should not smoke in homes
with children, and should be especially attentive to this
issue around toddlers."
Other authors include: Hong Huang, M.D., Ph.D.;
Lisa Nicholson, Ph.D.; Danielle Frock, B.S.;
Catherine Schroeder, B.S.; and Jennifer Kuck,
The Flight Attendant Medical Research Institute (FAMRI) funded
Statements and conclusions of abstract authors that are
presented at American Heart Association/American Stroke
Association scientific meetings
are solely those of the abstract authors and do not
necessarily reflect association policy or position. The
associations make no representation or
warranty as to their accuracy or reliability.
Editors Note: The American Heart Association strongly supports
the Family Smoking Prevention and Tobacco Control Act,
legislation giving the Food and Drug Administration (FDA)
adequately funded and meaningful authority over the
manufacture, sale, distribution, labeling and promotion of
tobacco products. The association also advocates for
comprehensive clean indoor workplace policies, as well as
increases in tobacco excise taxes and tobacco control
prevention and cessation programs.
Source: American Heart Association
Concise Encyclopedia and Internet Press Office
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