Declines in Acute Myocardial Infarction After Smoke-Free Laws and Individual Risk Attributable to Secondhand Smoke

Author:

Lightwood James M.1,Glantz Stanton A.1

Affiliation:

1. From the School of Pharmacy (J.M.L.) and Department of Medicine (Cardiology), Cardiovascular Research Institute, and Center for Tobacco Control Research and Education, School of Medicine (S.A.G.), University of California, San Francisco.

Abstract

Background— The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack. The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood. The objective is to determine the consistency of estimates of reductions in community rates of heart attacks resulting from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking. Methods and Results— Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates. The outcome measure is the ratio of community rates of acute myocardial infarction (after divided by before implementation of a smoking restriction law). There is a significant drop in the rate of acute myocardial infarction hospital admissions associated with the implementation of strong smoke-free legislation. The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law. The pooled random-effects estimate of the rate of acute myocardial infarction hospitalization 12 months after implementation of the law is 0.83 (95% confidence interval, 0.80 to 0.87), and this benefit grows with time. This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios. Conclusion— Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infarctions, and these benefits grow with time.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference41 articles.

1. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. Bethesda Md: California Environmental Protection Agency; 1999. National Cancer Institute Smoking and Health monograph 10.

2. California Environmental Protection Agency. Health Effects of Exposure to Environmental Tobacco Smoke. Sacramento Calif: Office of Environmental Health Hazard Protection California Environmental Protection Agency; 2005.

3. USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta Ga: US Department of Health and Human Services US 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.

4. Cardiovascular Effects of Secondhand Smoke

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