Letter by Vogt Regarding Article, “Reduction in the Incidence of Acute Myocardial Infarction Associated With a Citywide Smoking Ordinance”
To the Editor:
I read with interest the article by Bartecchi et al.1 I applaud the authors for studying the relationship between the incidence of acute myocardial infarction (AMI) and the enactment of a smoke-free ordinance in one community. However, the results need to be interpreted with caution. The authors of the study employed a before–after study design that lacks scientific rigor in clearly establishing a relationship between AMIs and the smoke-free ordinance. The authors’ finding is notable but is somewhat diminished by the fact that there are no data on exposure to active or passive smoking presented in this study, which would have provided more convincing evidence of a true association. It was interesting to see that there were no similar reductions of AMIs in surrounding communities that did not have an ordinance change. However, there could be other, unknown reasons for the reduction of AMIs in Pueblo in the 18 months after the ordinance was instituted. In the future, it would be helpful for researchers studying similar communities to obtain both active and passive smoking exposure data to better determine the association with a change in incidence of AMIs or other cardiovascular events. Fortunately, there are multiple other, more rigorous studies that have shown a true health risk due to active and passive smoke exposure.