Assessing Causality Between Second-Hand Smoking and Potentially Associated Diseases in Multiple Systems: A Two-Sample Mendelian Randomization Study

Abstract

Introduction The global disease burden may be exacerbated by exposure to passive smoking (SHS), with the workplace being a primary location for such exposure. Numerous epidemiological studies have identified SHS as a risk factor for diseases affecting various systems, including cardiovascular, respiratory, immune, endocrine, and nervous systems. The conventional observational study has certain methodological constraints which can be circumvented through a Mendelian randomization (MR) study. Our MR study intends to investigate the causal link between workplace exposure to SHS and the potential associated diseases. Methods Summary statistics data involving European participants was sourced from three databases: the UK Biobank, the FinnGen study, and the European Bioinformatics Institute. Genetic variants linked with exposure to SHS in the workplace were identified as instrumental variables. The MR was carried out using inverse variance weighted (IVW), MR-Egger, and weighted median methods. Sensitivity tests were also undertaken within the MR to evaluate the validity of the causality. Results According to the IVW model, genetically determined atrial fibrillation (AF) and stroke [P= 6.64E-04 and 5.68E-07, odds ratio = 2.030 and 2.494, 95% confidence interval = 1.350,3.051 and 1.743,3.569] were robustly associated with exposure to SHS in the workplace. Suggestive associations were found between workplace SHS and myocardial infarction (MI), asthma, and depression. Conclusions The MR study demonstrates that exposure to SHS in the workplace is a significant risk factor for AF and stroke in European individuals. Whether workplace exposure to SHS influences other diseases and the causality between them requires further exploration. Implications This study explored the causality between exposure to SHS in the workplace and potential associated diseases in multiple systems, including MI, AF, stroke, lung cancer, asthma, allergic disease, type 2 diabetes, and depression, using a MR study. The MR study can circumvent the methodological constraints of observational studies and establish a causal relationship. The two-sample MR analysis provides evidence supporting the causal association of frequent workplace SHS with AF and stroke. Individuals exposed to SHS in the workplace may also have a heightened risk of MI, asthma, and depression. However, whether SHS affects other diseases and the causality between them requires further investigation. To our knowledge, this is the first two-sample MR study to determine the causal relationship between SHS and potential diseases. As exposure to SHS in the workplace is a prevalent issue and may contribute to a global disease burden. The reduction of exposure following the introduction of smoke-free laws has led to a decrease in the admission rate for cardiac events and an improvement in health indicators. It is crucial to further advance smoke-free policies and their implementation.

Drug-induced AF: Arrhythmogenic Mechanisms and Management Strategies

“…111 In addition, exposure to environmental tobacco smoke has also been linked to an increased prevalence of AF, even among non-smokers. 112,113 Nicotine, the primary active ingredient in tobacco, has both addictive and sympathomimetic properties, which can trigger AF by stimulating sympathetic neurotransmission and increasing sympathetic activity. 114 Nicotine is also profibrotic and the fibrosis provides the arrhythmogenic substrate.…”