Myocardial Infarction and Sudden Cardiac Death in Olmsted County, Minnesota, Before and After Smoke-Free Workplace Laws

Study Questions:

What are the population effects of the implementation of smoke-free laws on cardiovascular events?

Methods:

To evaluate the population impact of smoke free laws, the investigators measured, through the Rochester Epidemiology Project, the incidence of myocardial infarction (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 < 0.001), from 150.8 to 100.7 per 100,000 population, and the incidence of sudden cardiac death declined by 17% (p = 0.13), 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:

The authors concluded that a substantial decline in the incidence of MI was observed after smoke-free laws were implemented.

Perspective:

This study reports a substantial decline in the incidence of MI after a comprehensive smoke-free workplace law was implemented. The magnitude of this decline, which is similar to the 40% decrease in the first report in Helena, Montana, is not explained by concomitant community interventions or changes in cardiovascular risk factors, with the exception of smoking prevalence. Based on this and other data, exposure to secondhand smoke (SHS) should be considered a modifiable risk factor for MI. All people should avoid SHS exposure as much as possible, and those with coronary heart disease should avoid any exposure to SHS.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Homozygous Familial Hypercholesterolemia, Hypertension, Smoking

Keywords: Coronary Artery Disease, Myocardial Infarction, Tobacco Smoke Pollution, Minnesota, Risk Factors, Electrocardiography, Hypercholesterolemia, Smoking, Prevalence, Biological Markers, Cardiovascular Diseases, Obesity, Workplace, Hypertension, Diabetes Mellitus, Death, Sudden, Cardiac


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