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Compared with the most recent published meta-analysis,5 our review excluded two studies that have been included in subsequent publications w176 w183 and one study with no risk estimate for never smokers, w73 and included four studies published in the past two years.13 14 15 16 Our meta-analysis provides consistent evidence of a moderate increase in risk of fatal myocardial infarction and fatal stroke, whereas it does not provide evidence of a difference in effect of products consumed in North America compared with northern Europe

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Previous studies have documented that CS exposure induces histomorphological changes in the respiratory epithelium, including epithelial cell hyperplasia, metaplasia with keratinization, and ciliary loss with neutrophilic infiltration 20,21,22,23

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