Smoke-Free Workplace Laws Linked to Lower Incidence of Heart Attacks

No Smoking Laws Linked to a Decline in Heart Attacks and Heart Attack Deaths.A new study published in the Archives of Internal Medicine, a journal of the American Medical Association, has found an association between smoke-free workplace laws implemented in Olmstead County, Minnesota and a decline in the incidence of heart attacks and heart attack deaths thereafter experienced in that County.

The new study, conducted by Richard D. Hurt, M.D., and colleagues at the Mayo Clinic in Rochester, Minnesota (which is located in Olmstead County, Minnesota), was published in the October, 2012 online issue of the Archives of Internal Medicine.

According to background information written by the authors as an introduction to the new study report, previous research has found that exposure to secondhand smoke is associated with coronary heart disease in nonsmokers, and the cardiovascular effects of secondhand smoke are nearly as large as those from active smoking.

Therefore, the authors note, smoke-free laws and policies that eliminate smoking in public places have the potential directly to reduce cardiovascular events from secondhand smoke, as well as potentially to reduce smoking, and thereby reduce heart attacks attributable to smoking itself.

In 2002, a smoke-free restaurant ordinance was implemented and, in 2007, all workplaces, including bars, became smoke free in Olmstead County, Minnesota. This provided the researchers the opportunity to evaluate the incidence of heart attacks and death from sudden cardiac events in that County, during periods before and after the implementation of those ordinances.

The new study was supported in part by a grant from ClearWay Minnesota, a grant from the National Heart, Lung and Blood Institute/National Institutes of Health, and a grant from the National Institute on Aging/National Institutes of Health.

The Study; Method

The researchers evaluated the incidence of myocardial infarction (heart attacks) and sudden cardiac death in Olmsted County, Minnesota, during the 18-month periods before and after implementation of each of the smoke-free ordinances.

According to the researchers, “All MIs [myocardial infarctions, which means heart attacks] 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.”


“We report a substantial decline in the incidence of MI [myocardial infarction, which means heart attacks] from 18 months before the smoke-free restaurant law was implemented to 18 months after the comprehensive smoke-free workplace law was implemented five years later,” the authors wrote.

“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%, from 150.8 to 100.7 per 100 000 population, and the incidence of sudden cardiac death declined by 17%, from 109.1 to 92.0 per 100 000 population,” the authors found.

“During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased,” they also found.

Conclusions; Implications

“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,” the authors wrote.

“As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends,” they concluded.

“Secondhand smoke exposure should be considered a modifiable risk factor for MI [heart attacks]. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke,” the authors conclude.

In Commentary published along with the study, in the October, 2012 online issue of the Archives of Internal Medicine, Sara Kalkhoran, M.D., and Pamela M. Ling, M.D., M.P.H., of the University of California, San Francisco, wrote: “The results of the study by Hurt et al highlight some of the potential benefits of 100 percent smoke-free policies in workplaces, restaurants and bars: significantly decreased incidence of myocardial infarction and a trend toward decreased sudden cardiac death.”

“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,” they continue.

“Exposure to SHS [secondhand smoke] should not be a condition of employment, and all workers, including those of lower income and those in the service and hospitality industries, should have equal protection from SHS exposure,” they conclude.

More Information

The report of the new study can be found in its entirety in the October, 2012 online issue of the Archives of Internal Medicine, a journal of the American Medical Association.

For information on the health effects of Smoking, and information on programs to help you quit smoking, see the HelpingYouCare® resource page on Quit Smoking & Other Practices for Healthy Living.

For more information on a healthy diet, exercise and other lifestyle factors that promote wellness and prevent diseases, see the HelpingYouCare® resource pages on Wellness/ Healthy Living for Seniors & Caregivers, including:


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