La tasa de infartos de miocardio se reduce de forma significativa después de implantar leyes que prohíben fumar en espacios públicos, según demuestra el estudio publicado el 29 de octubre en Archives of Internal Medicine.
El Condado de Olmsted (Minnesota) prohibió fumar en los restaurantes el 1 de enero de 2002 y amplió dicha prohibición a todos los lugares de trabajo, incluidos los bares, el 1 de octubre de 2007. La inhalación de humo del tabaco incrementa el riesgo de padecer ataques al corazón, los autores del estudio comparan las tasas de ataque al corazón en los 18 meses anteriores a la promulgación de la primera ordenanza y en los 18 meses posteriores a la prohibición total.
El condado tiene cerca de 145.000 habitantes. Los registros médicos indican que se produjeron 187 ataques cardíacos en los 18 meses anteriores a la primera prohibición y 139 en el mismo período de tiempo inmediatamente después de la prohibición completa. Cuando los resultados se ajustan a los cambios demográficos, los datos revelan tasas de ataques cardiacos anuales de 151 por cada 100.000 personas antes y 101 por 100.000 después
El condado de Olmsted no es el primero en promulgar este tipo de leyes, pero dispone de una exhaustiva base de datos sanitarios de su población. Los resultados han impresionado incluso a los promotores de las restricciones. Según Pamela Ling, internista de la Universidad de California "Al principio, cuando se aprobaron estas ordenanzas, nadie esperaba realmente obtener resultados tan rápidamente, pero la evidencia que vincula las políticas antitabaco y los resultados médicos, es realmente muy fuerte". Otro de los argumentos era que las políticas a favor de ambientes libres de humo se cumplirían en el lugar de trabajo, pero que la gente fumaría más en casa, pero según Ling. "Los estudios sugieren realmente que la gente no hace eso”.
El estudio es, hasta la fecha, el análisis más largo que mide el efecto de una ordenanza de fumar sobre la salud cardíaca toda una comunidad, y según Richard Hurt, un internista de la Clínica Mayo en Rochester, Minnesota, y uno de los autores del trabajo “Nuestra esperanza es que esto permita pasar página acerca de la cuestión de si el humo del tabaco está o no asociado a los ataques al corazón”. Hurt tiene esperanzas de que la ética antitabaco se extienda a los automóviles. “Cuando alguien fuma en un coche, la concentración de humo de tabaco es simplemente increíble."
The heart attack rate drops in a significant way after banning smoking in public places, as shows a study published in the Oct. 29 Archives of Internal Medicine.
Olmsted County prohibited smoking in restaurants on January 1, 2002, and expanded the ban to all workplaces, including bars, on October 1, 2007. Cigarette smoke inhalation increases heart attack risk, so the authors of the study calculated the rate of heart attacks during the 18 months preceding the enactment of the first ordinance and the 18 months immediately after the full ban went into effect.
The county has a population of nearly 145,000 people. Medical records show 187 heart attacks there in the 18 months before the first smoking ban and 139 in the same time frame immediately after the full prohibition began. When adjusted to account for demographic changes in the county's population between the two periods, the data revealed an annual heart attack rate of 151 per 100,000 people before and 101 per 100,000 afterward.
Olmsted County is hardly the first to enact curbs on public smoking, but the county benefits from having an exhaustive medical database of its residents to analyze. The findings impress even those who promoted smoking bans early on. According to Pamela Ling, an internist at the University of California, “initially, when these ordinances were passed, anyone really expected to see such a rapid cardiovascular effect. But I think the evidence linking smoke-free policies and real medical outcomes, is really quite strong”. Other of the arguments was that smoke-free policies would restrict it in the workplace but that people would smoke more at home, but Ling says. “But actually, studies suggest ... that people don’t compensate.”
The study is the longest analysis to date to measure a smoking ordinance’s effect on community-wide heart health, and according to study coauthor Richard Hurt, an internist at the Mayo Clinic in Rochester, Minnesota, “our hope is that this will turn the page on this chapter, and whether secondhand smoke is associated with heart attacks.” Hurt says he hopes the emerging antismoking ethic will now spread to automobiles. “When someone smokes in a car, the concentration of secondhand smoke is just amazing.”
Taken from Science News
Resumen de la publicación/Abstract of the paper
Myocardial Infarction and Sudden Cardiac Death in Olmsted County, Minnesota, Before and After Smoke-Free Workplace Laws
R.D. Hurt; S.A. Weston; J.O. Ebbert; S.M. McNallan; I.T. Croghan; D.R. Schroeder; V.L. Roger
Arch Intern Med. 2012;():1-7. doi:10.1001/2013.jamainternmed.46
Published oline 28 October 2012
Abstract
Background 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 in that setting. In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces, including bars, became smoke free.
Methods To evaluate the population impact of smoke-free laws, we measured, through 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. All MIs 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.
Results 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% (P < .001), from 150.8 to 100.7 per 100 000 population, and the incidence of sudden cardiac death declined by 17% (P = .13), from 109.1 to 92.0 per 100 000 population. During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased.
Conclusions 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. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke.
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