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.

译文

背景:在已实施无烟工作场所法律的地区,已有报道称心肌梗死(MI)的住院人数有所减少,但尚无研究评估该地区的突发性心脏病死亡。 2002年,明尼苏达州的奥尔姆斯特德县实施了无烟餐厅条例,2007年,包括酒吧在内的所有工作场所都实现了无烟。
方法:为了评估无烟法律对人口的影响,我们通过罗切斯特流行病学项目测量了在实施每项无烟条例前后的18个月内,奥尔姆斯特德县的心肌梗死和心源性猝死的发生率。使用严格的标准化标准(依赖于生物标志物,心脏疼痛和心电图的明尼苏达州编码),对所有MI进行连续提取和验证。猝死定义为与冠心病相关的院外死亡。
结果:与实施无烟餐厅条例之前的18个月与实施无烟餐厅工作场所法之后的18个月相比,心梗的发生率下降了33%(P <.001),从每15万人的150.8下降到100.7心脏猝死的发生率下降了17%(P = 0.13),从每10万人口中的109.1下降到92.0。在同一时期,吸烟率下降,而高血压,糖尿病,高胆固醇血症和肥胖症的发生率则保持不变或上升。
结论:实施无烟法律后,心肌梗死的发生率显着下降,除吸烟率外,社区共同干预措施或心血管危险因素的变化均不能解释其严重程度。由于其他危险因素的趋势似乎无法解释,因此,无烟工作场所法律似乎与这些有利趋势在生态上相关。二手烟暴露应被视为可改变的心梗危险因素。所有人都应尽可能避免二手烟,患有冠心病的人也不应接触二手烟。

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