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Health & Medicine for Senior Citizens

Big Decline in Heart Attacks, Cardiac Deaths in County After Smoke-Free Workplace Laws

Heart attacks drop by 33 percent, sudden cardiac deaths by 17 percent after protection from secondhand smoke; seniors should take note
> In a second study released today a world-wide look finds hospitalizations drop with restrictions on public smoking; see below lead story

Oct. 29, 2012 – There was a substantial drop in heart attacks and sudden cardiac deaths in a Minnesota county after it implemented laws to ban smoking in restaurants, bars and all workplaces, according to an evaluation from the Mayo Clinic in Rochester. Senior citizens are the most common victims of these coronary problems and may benefit most from laws to restrict public smoking.

Exposure to secondhand smoke (SHS) has been associated with coronary heart disease (CHD) in nonsmokers, and earlier research suggests that the cardiovascular effects of SHS are about as large as those with active smoking, according to the study published Online First by Archives of Internal Medicine, a JAMA Network publication.

The theory has been that elimination of smoking in public places, such as by smoke-free laws and policies, has the potential for reducing smoking and perhaps cardiovascular problems.


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The Mayo researchers, led by Richard D. Hurt, M.D., evaluated the incidence of myocardial infarction (MI, heart attack) and sudden cardiac death (SCD) in Olmsted County, Minn., during the 18-month period before and after implementation of smoke-free ordinances.

Older People Should Avoid Secondhand Smoke

You don't have to be a smoker for smoking to harm you. You can also have health problems from breathing in other people's smoke. Secondhand smoke is the combination of smoke that comes from the burning end of a cigarette, cigar or pipe and the smoke exhaled by the smoker.

Secondhand smoke contains more than 50 substances that can cause cancer.

Health effects of exposure to secondhand smoke include lung cancer, nasal sinus cancer, respiratory tract infections and heart disease.

There is no safe amount of secondhand smoke. Children, pregnant women, older people and people with heart or breathing problems should be especially careful.

>> Secondhand Smoke and Cancer - NIH: National Cancer Institute

>> Report of the Surgeon General: How Tobacco Smoke Causes Disease (Centers for Disease Control and Prevention) - PDF

In 2002, a smoke-free restaurant ordinance was implemented and, in 2007, all workplaces, including bars, became smoke free.

“We report a substantial decline in the incidence of MI 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 comment.

When 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 number of heart attacks declined by 33 percent from about 150.8 to 100.7 per 100,000 population.

And, the incidence of sudden cardiac deaths declined by 17 percent from 109.1 to 92 per 100,000 population.

“All people should avoid SHS exposure as much as possible, and those with CHD (coronary heart disease) should have no exposure to SHS (secondhand smoke),” the authors conclude.

The study highlights 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,” according to a commentary by Sara Kalkhoran, M.D., and Pamela M. Ling, M.D., M.P.H., of the University of California, San Francisco.

“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 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.

The study was supported in part by a grant from ClearWay Minnesota, a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health and a grant from the National Institute on Aging of the National Institutes of Health. Commentary: Extending the Health Benefits of Clean Indoor Air Policies

Second study on secondhand smoke

Smoke-Free Laws Led Quickly to Fewer Hospitalizations

45 studies covered 33 smoke-free laws around U.S., world

Oct. 29, 2012 - Smoke-free legislation was associated with substantially fewer hospitalizations and deaths from heart and respiratory diseases, according to research in the American Heart Association journal Circulation.

Researchers reviewed 45 studies covering 33 smoke-free laws at the local and state levels around the United States and from countries as varied as Uruguay, New Zealand and Germany and found:

   ● Comprehensive smoke-free laws were associated with a rapid 15 percent decrease in heart attack hospitalizations and 16 percent decrease in stroke hospitalizations.

   ● Smoke-free laws were also rapidly followed by a 24 percent decrease in hospitalizations for respiratory diseases, including asthma and chronic obstructive pulmonary disease.

   ● The most comprehensive laws — those covering workplaces, restaurants and bars — resulted in the highest health benefits.

"The public, health professionals and policy makers need to understand that including exemptions and loopholes in legislation – such as exempting casinos – condemns more people to end up in emergency rooms," said Stanton Glantz, Ph.D., senior study author and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

"These unnecessary hospitalizations are the real cost of failing to enact comprehensive smoke-free legislation."

The findings support the American Heart Association's position that smoke-free laws should be comprehensive and apply to all workplaces and public environments, including restaurants, bars and casinos. The analysis also is consistent with other studies that have found smoke-free laws were followed by significant decreases in acute heart attack and other cardiac-related hospital admissions.

"Stronger legislation means immediate reductions in secondhand smoke-related health problems as a byproduct of reductions in secondhand smoke exposure and increases in smoking cessation that accompany these laws," Glantz said. "Passage of these laws formalize and accelerate social change and the associated immediate health benefits."

The National Cancer Institute funded the study.


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