A recent decline in the incidence of myocardial infarction (MI) in Olmsted County, Minnesota, USA, could be due to the implementation of smoke-free laws, researchers suggest.
Richard Hurt (Mayo Clinic, Rochester, Minnesota, USA) and team found that the incidence of MI significantly declined by 33%, from 150.8 cases per 100,000 population in the 18 months before a smoke-free restaurant law was implemented in Olmsted County in 2002, to 100.7 cases per 100,000 population in the 18 months after a workplace smoke-free policy was implemented in 2007.
In addition, the incidence of sudden cardiac death (SCD) declined by 17%, from 109.1 per 100,000 population to 92.0 per 100,000 population. However, this decline was nonsignificant.
The researchers say that during 2000-2010, the self-reported prevalence of smoking decreased significantly from 19.8% to 14.9%. By contrast, the prevalence of diabetes mellitus increased from 5% in 2004 to 6.5% in 2010, and obesity (body mass index ≥30) increased from 17% in 2000 to 25% in 2010.
Meanwhile, the prevalence of hypertension and hypercholesterolemia was unchanged. Trends in these other cardiovascular risk factors therefore do not appear to explain the decline in MI, the researchers note.
"We believe that secondhand smoke exposure could be considered a major risk factor for MI, joining family history, hypertension, hyperlipidemia, diabetes mellitus, and low physical activity," write Hurt et al in the Archives of Internal Medicine. "Hence, all clinicians should ascertain secondhand smoke exposure as part of their lifestyle recommendations."
Hurt and team also urge all clinicians to advocate tobacco control policies such as increased tax, graphic labeling, smoke-free workplaces, and marketing and advertising restrictions, "since smoking and secondhand smoke exposure are responsible for 10% of all cardiovascular deaths globally."
In a related editorial, Sara Kalkhoran and Pamela Ling, both from the University of San Francisco in the USA, write: "The results of the study by Hurt et al highlight some of the potential benefits of 100% smoke-free policies in workplaces, restaurants, and bars: significantly decreased incidence of MI and a trend toward decreased SCD."
They continue: "Moving forward, we should prioritize the enforcement of smoke-free policies, eliminating loopholes in existing policies as well as encouraging expansion of smoke-free policies to include multiunit housing, motor vehicles, casinos and outdoor locations."
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