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. 2012 Nov 26;172(21):1635-41.
doi: 10.1001/2013.jamainternmed.46.

Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws

Richard D Hurt  1 , Susan A Weston, Jon O Ebbert, Sheila M McNallan, Ivana T Croghan, Darrell R Schroeder, Véronique L Roger
Affiliations

Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws

Richard D Hurt et al. Arch Intern Med. .

Abstract

Background: Reductions in admissions for myocardial infarction (MI) have been reported in locales where smoke-free workplace laws have been implemented, but no study has assessed sudden cardiac death in that setting. In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces, including bars, became smoke free.

Methods: To evaluate the population impact of smoke-free laws, we measured, through the Rochester Epidemiology Project, the incidence of MI and sudden cardiac death in Olmsted County during the 18-month period before and after implementation of each smoke-free ordinance. All MIs were continuously abstracted and validated, using rigorous standardized criteria relying on biomarkers, cardiac pain, and Minnesota coding of the electrocardiogram. Sudden cardiac death was defined as out-of-hospital deaths associated with coronary disease.

Results: Comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33% (P < .001), from 150.8 to 100.7 per 100,000 population, and the incidence of sudden cardiac death declined by 17% (P = .13), from 109.1 to 92.0 per 100,000 population. During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased.

Conclusions: A substantial decline in the incidence of MI was observed after smoke-free laws were implemented, the magnitude of which is not explained by community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Incidence of MI and SCD in Olmsted County, Minnesota, 1995–2009, with smoothing spline and 95% confidence intervals.
Figure 2
Figure 2
Prevalence of Self-Reported Current Smoking in Minnesota, 1995–2010 from Behavioral Risk Factor Surveillance System Survey Data
Figure 3
Figure 3
Prevalence of self-reported high cholesterol, diabetes, hypertension and obesity in Minnesota, 1995–2010 from Behavioral Risk Factor Surveillance System Survey Data
See this image and copyright information in PMC

Comment in

  • Extending the health benefits of clean indoor air policies.
    Kalkhoran S, Ling PM. Kalkhoran S, et al. Arch Intern Med. 2012 Nov 26;172(21):1642-3. doi: 10.1001/2013.jamainternmed.269. Arch Intern Med. 2012. PMID: 23108338 No abstract available.
  • Causal effect of public space smoking bans?
    Huesch MD. Huesch MD. JAMA Intern Med. 2013 May 13;173(9):835-6. doi: 10.1001/jamainternmed.2013.84. JAMA Intern Med. 2013. PMID: 23700021 No abstract available.
  • Smoking bans research.
    Arnett J Jr, Dunn JD. Arnett J Jr, et al. JAMA Intern Med. 2013 May 13;173(9):836. doi: 10.1001/jamainternmed.2013.87. JAMA Intern Med. 2013. PMID: 23700022 No abstract available.
  • Smoking bans research--reply.
    Hurt RD, Roger VL, Ebbert JO. Hurt RD, et al. JAMA Intern Med. 2013 May 13;173(9):836-7. doi: 10.1001/jamainternmed.2013.928. JAMA Intern Med. 2013. PMID: 23700023 No abstract available.

References

    1. Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke: nearly as large as smoking. Circulation. 2005;111(20):2684–2698. - PubMed
    1. Celermajer DS, Adams MR, Clarkson P, et al. Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. N Engl J Med. 1996;334(3):150–154. - PubMed
    1. Raitakari OT, Adams MR, McCredie RJ, Griffiths KA, Celermajer DS. Arterial endothelial dysfunction related to passive smoking is potentially reversible in healthy young adults. Ann Intern Med. 1999;130(7):578–581. - PubMed
    1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
    1. National Cancer Institute, National Institutes of Health. [Accessed June 20, 2011.];Smoking and Tobacco Control Monographs, Monograph 10: Health Effects of Exposure to Environmental Tobacco Smoke. http://cancercontrol.cancer.gov/tcrb/monographs/10/

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