Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws.
Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws.
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DOI：
10.1001/2013.jamainternmed.46
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发表时间：
2012-11-26
影响因子：
--
通讯作者：
Roger, Veronique L.
中科院分区：
文献类型：
--
作者：
Hurt, Richard D.;Weston, Susan A.;Ebbert, Jon O.;McNallan, Sheila M.;Croghan, Ivana T.;Schroeder, Darrell R.;Roger, Veronique L.
据报道，在实施无烟工作场所法的地区，因心肌梗死 (MI) 入院的人数有所减少，但尚无研究评估心源性猝死 (SCD) 的情况。 2002年，明尼苏达州奥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全面禁烟。为了评估无烟法规对人口的影响，我们通过罗切斯特流行病学项目测量了奥姆斯特德县在每项无烟法规实施前后 18 个月期间心肌梗塞和猝死的发病率。所有 MI 均根据生物标志物、心脏疼痛和心电图明尼苏达编码，使用严格的标准化标准不断提取和验证。 SCD 被定义为因冠心病导致的院外死亡。比较《无烟餐厅条例》实施前18个月与《无烟工作场所法》实施后18个月，心肌梗死发病率从每10万人口150.8人下降至100.7人，下降33%（P<0.01）；SCD发病率从每10万人109.1人下降至92.0人，下降17%（P=0.13）。 10万人口。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患病率保持不变或上升。无烟法实施后，心肌梗死的发病率大幅下降，但其幅度无法用社区共同干预措施或除吸烟率之外的心血管危险因素的变化来解释。由于其他风险因素的趋势似乎无法解释，无烟工作场所法似乎与这些有利趋势在生态上相关。二手烟 (SHS) 暴露应被视为 MI 的可改变危险因素。所有人都应尽可能避免二手烟，患有冠心病的人不应接触二手烟。
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 (SCD). In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces including bars became smoke free. To evaluate the population impact of smoke-free laws, we measured, through the Rochester Epidemiology Project, the incidence of MI and SCD 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. SCD was defined as out-of-hospital deaths assigned to coronary disease. Comparing the 18 months before the implementation of the smoke-free restaurant ordinance to the 18 months after the implementation of the smoke-free workplace law, the incidence of MI declined by 33% (P<0.01) from 150.8 to 100.7 per 100,000 population, and the incidence of SCD 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 while that of hypertension, diabetes, hypercholesterolemia, and obesity either remained constant or increased. 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 co-interventions 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 ecologically related to these favorable trends. Secondhand smoke (SHS) exposure should be considered a modifiable risk factor for MI. All people should avoid SHS to the extent possible, and people with known coronary heart disease should have no exposure to SHS.
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