Smoke-free workplace laws lead to decline in MI incidence

Following implementation of workplace smoke-free laws, the incidence of myocardial infarction decreased significantly in Olmsted County, Minn., according to a study published online Oct. 29 in the Archives of Internal Medicine.

05 nov 2012—Following implementation of workplace smoke-free laws, the incidence of myocardial infarction (MI) decreased significantly in Olmsted County, Minn., according to a study published online Oct. 29 in the Archives of Internal Medicine.

To evaluate the population impact of smoke-free laws, Richard D. Hurt, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues utilized data from 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 was assessed.

The researchers found that the incidence of MI declined significantly by 33 percent, from 150.8 to 100.7 per 100,000 population when comparing the 18 months before implementation of the smoke-free restaurant ordinance (implemented in 2002) with the 18 months after implementation of the smoke-free workplace law (implemented in 2007). During the same period, the incidence of sudden cardiac death decreased by 17 percent (P = 0.13), from 109.1 to 92.0 per 100,000 population. While the prevalence of smoking declined, the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased during the same period.

"The implementation of smoke-free workplace ordinances was associated with a substantial decrease in MI, the magnitude of which is not explained by concomitant community interventions or changes in cardiovascular risk factors, with the exception of smoking prevalence," the authors write. "Exposure to secondhand smoke should be considered a modifiable risk factor for MI."

More information: Abstract 
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WHO: Smoking kills 5 million every year

LONDON, 10 dec 2009 – Tobacco use kills at least 5 million people every year, a figure that could rise if countries don't take stronger measures to combat smoking, the World Health Organization said Wednesday.

In a new report on tobacco use and control, the U.N. agency said nearly 95 percent of the global population is unprotected by laws banning smoking. WHO said secondhand smoking kills about 600,000 people every year.

The report describes countries' various strategies to curb smoking, including protecting people from smoke, enforcing bans on tobacco advertising, and raising taxes on tobacco products. Those were included in a package of six strategies WHO unveiled last year, but less than 10 percent of the world's population is covered by any single measure.

"People need more than to be told that tobacco is bad for human health," said Douglas Bettcher, director of WHO's Tobacco-Free Initiative. "They need their governments to implement the WHO Framework Convention."

Most of WHO's anti-tobacco efforts are centered on the Framework Convention on Tobacco Control, an international treaty ratified by nearly 170 countries in 2003. The convention theoretically obliges countries to take action to reduce tobacco use, though it is unclear if they can be punished for not taking adequate measures, since they can simply withdraw from the treaty.

Other experts questioned how effective WHO's strategies were.

"It's like the well-intentioned blind leading the blind," said Patrick Basham, director of the Democracy Institute, a London and Washington-based think tank. He said WHO's policies were based more on hope than evidence.

Basham said measures like increasing taxes on tobacco products and banning advertising don't address the root causes of why people smoke. Smoking levels naturally drop off — as they have in Western countries — when populations become richer and better-educated.

Tobacco use is the leading preventable cause of death and WHO estimates that, unless countries take drastic action, tobacco could kill about 8 million people every year by 2030, mostly in developing countries.

Basham said officials should focus on anti-poverty measures to stem the smoking problem, though that is beyond WHO's mandate as a health agency.

"The cynical view is that the anti-tobacco lobby has itself now become an industry and we will never be able to do enough to stop smoking," Basham said. "Tobacco use will change, but it has very little to do with the kinds of things WHO is promoting."