Secondhand Smoke Linked to Early Vascular Aging in Flight Attendants

Flight attendants with past exposure to secondhand smoke (SHS) have preclinical signs of accelerated vascular aging, reports a study in the March Journal of Occupational and Environmental Medicine.

Abnormalities in vascular (blood vessel) characteristics and function might account for an increase in cardiovascular risk among flight attendants with remote in-cabin SHS exposure, according to the study by C. Noel Bairey-Merz, MD, of Cedars-Sinai Medical Center, Los Angeles, and colleagues. The study was supported by the Flight Attendant Medical Research Institute (FAMRI).

The study included 26 flight attendants with occupational exposure to SHS before the start of airline smoking bans: 1988 for domestic and 1995 for international flights. Most were women with no known cardiovascular risk factors; past or current smokers were excluded.

The flight attendants had nearly 14,000 hours of in-cabin SHS exposure over an average of 14 years. They underwent vascular testing to assess a number of blood vessel functional characteristics linked to cardiovascular disease risk.

The results showed abnormalities on several measures of vascular function: pulse pressure, augmentation index, and flow-mediated dilation. Other vascular tests, including blood pressure, were normal.

The abnormal results suggest increased arterial stiffness (decreased compliance) and impaired function of the inner lining (endothelial layer) of the blood vessels. These are signs of early vascular aging, which may have implications for future cardiovascular health. The researchers cite a previous study reporting a 3.5-fold increase in cardiac disease risk among female flight attendants.

Although preliminary, the new findings "suggest that flight attendants with in-cabin SHS prior to the airline smoking ban have preclinical accelerated vascular aging," Dr. Bairey Merz and coauthors conclude. Given that cardiovascular disease remains the leading cause of death in women and men, the researchers emphasize the need for larger studies evaluating the relationship between chronic SHS exposure and vascular health.
About the Author 
Dr. Bairey-Merz may be contacted for interviews at
ACOEM (, an international society of more than 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About the Journal of Occupational and Environmental Medicine 
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Wei J, Shufelt C, Oestreicher Stock E, et al. Vascular aging is accelerated in flight attendants with occupational secondhand smoke exposure. J Occup Environ Med. 2019;61(3):197-202.