ObjectivesTo estimate the prevalence of passive smoking in an Australian population, the magnitude of risk of myocardial infarction or coronary death associated with passive smoking and the extent to which fibrinogen concentrations might be affected by passive smoking.DesignA population‐based case–control study of myocardial infarction or coronary death and passive smoking, and measurement of fibrinogen in a random sample from the same population.Setting and participantsResidents of the Lower Hunter Region of New South Wales aged 35–69 years in 1988–1989. Case subjects were all those who suffered myocardial infarction or coronary death. Control subjects were participants in a risk factor prevalence survey.Outcome measuresMyocardial infarction or coronary death, defined by criteria of the WHO MONICA Project, and fibrinogen concentration (measured in controls only).ResultsPrevalence of passive smoking at home was 20% for male case subjects, 13% for male control subjects, 29% for female case subjects and 19% for female control subjects. The corresponding prevalence rates for passive smoking at work were 40%, 44%, 41% and 37%. Odds ratios of myocardial infarction or coronary death for active smokers compared with non‐smokers were 4.70 (95% confidence interval [CI], 3.35–6.58) in women and 2.71 (95% CI, 2.07–3.53) in men. For women the odds ratios of myocardial infarction or coronary death for those exposed to passive smoking at home were 2.46 (95% CI, 1.47–4.13) among non‐smokers and 1.48 (95% CI, 0.67–3.30) among ex‐smokers. For men the odds ratios for passive smoking at home were 0.97 (95% CI, 0.50–1.86) for non‐smokers and 1.78 (95% CI, 1.13–2.79) for ex‐smokers. The odds ratios for passive smoking at work did not suggest increased risk. Fibrinogen concentrations were generally higher among people exposed to passive smoking at home or work compared with those not exposed but were not as high as concentrations in active smokers.ConclusionsPassive smoking increases the risk of coronary heart disease and increased fibrinogen concentration provides a marker of its effect.