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This seems to be the case for lung cancer, for which the large American Cancer Society Prevention Study II showed an approximately linear relation between risk of lung cancer and number of cigarettes smoked per day, but the dose-response for cardiovascular disease is steep at low consumption and then levels off,10 consistent with the shape reported previously.11 In a seminal systematic review of second-hand smoke and coronary heart disease among never smokers published in the BMJ 20 years ago, Law and colleagues drew attention to the 1.30 risk ratio being relatively large compared with the 2-3 typically seen in studies of active smokers.12 Their conclusions on second-hand smoke were supported by a meta-analysis of active cigarette smoking and risk of coronary heart disease from five cohort studies, in which the modelled relative risk for smoking one cigarette per day (1.39) was consistent with that for exposure to second-hand smoke

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