Hospital admission and mortality rate for acute myocardial infarction and stroke before and after the enactment of the smoking ban law in São Paulo city

Introdução - As leis de restrição ao fumo têm sido amplamente difundidas pelo mundo principalmente na última década. Estudos prévios e meta análises têm demonstrado uma redução nas taxas de infarto do miocárdio após a vigência dessas leis. Entretanto, para a população latino-americana, as informações ainda são escassas. Na primeira fase deste estudo foi demonstrada a implementação bem sucedida da lei anti fumo na cidade de São Paulo, com uma redução expressiva nos níveis de monóxido de carbono em restaurantes, bares e casas noturnas. Objetivo - Avaliar se a implementação da lei anti fumo na cidade de São Paulo em 2009 foi associada a uma redução nas taxas de mortalidade e internação hospitalar por infarto do miocárdio e acidente vascular cerebral. Métodos - Foi realizado um estudo de séries temporais mensais entre janeiro de 2005 e dezembro de 2010. Os dados foram provenientes do DATASUS, o principal sistema de informação pública de saúde disponível no Brasil e do Sistema de Informação sobre Mortalidade (SIM). A análise foi realizada utilizando o método Auto-regressivo, Integrado e de Médias Móveis com variáveis exógenas (ARIMAX), modelado por variáveis ambientais e poluentes atmosféricos para avaliar as taxas de mortalidade e internação hospitalar antes da lei e prever os eventos após a lei. Também foi realizada análise utilizando o método de Análise de Séries Temporais Interrompida (ITSA), em conjunto com o ARIMAX, para comparar o período anterior à lei, o momento em que entrou em vigor e o período após a lei. Resultados - Foi observada uma redução nas taxas de internação hospitalar (-5.4% nos primeiros 3 meses após a lei) e mortalidade (-11.9% nos primeiros 17 meses após a lei) por infarto do miocárdio com o método ARIMAX e uma redução na taxa de internação hospitalar (-7,4% entre o 7º e o 12º mês após a lei) e mortalidade (-5,3% nos primeiros 17 meses após a lei) por acidente vascular cerebral, com a mesma metodologia. Conclusão - As taxas de internação hospitalar e mortalidade por infarto do miocárdio e acidente vascular cerebral foram reduzidas após o início da vigência da lei anti fumoBackground - Smoking restriction laws have spread worldwide during the last decade. Previous studies and meta-analyses have shown a decline in the community rates of myocardial infarction and/or heart attack after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in places like restaurants, bars, and nightclubs. Objective - To evaluate whether the 2009 implementation of a smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction and stroke. Methods - We performed a time series study of monthly rates of mortality and hospital admissions for acute myocardial infarction and stroke from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modeled by environmental variables and atmospheric pollutants to evaluate the mortality and hospital admission rate before the law and forecast events after the law. We also used Interrupted Time Series Analysis (ITSA) in conjunction with ARIMAX to compare the period before the law, the moment of implementation of the law, and the period after the law. Results - We observed a reduction in hospital admission rate (-5.4% in the first 3 months after the law) and mortality rate (-11.9% in the first 17 months after the law) for myocardial infarction with ARIMAX method. We observed a reduction in hospital admission rate (-7,4% between the 7th and the 12th month after the law) and mortality rate (-5,3% in the first 17 months after the law) for stroke with ARIMAX method. Conclusions - Hospital admission rate and mortality rate for myocardial infarction and stroke were reduced after the smoking ban law was implemente

Could be applied genetic markers to smoking cessation treatment?

Background The interruption of smoking is the best way to prevent diseases. The perspective of using genetic markers, which indicate more effectiveness to the tobacco treatment, can change this scenario bringing more objectivity in the treatment of this disease. Pharmacogenomics of smoking treatment was evaluated in over 1000 patients in our Smoking Cessation Center between 2009 to 2014 period. We found the association of the CHRNA4 rs1044396 polymorphism with varenicline therapy. Patients with CT or TT genotypes had a higher chance of success than CC(OR = 1.67; CI = 1.10 -2.53; p = 0.02). We also found the association of the CYP2B6 rs2279343 polymorphism with bupropion therapy. Patients with AA genotype had a higher chance of success compared to AG or GG genotypes (OR = 1.92; IC = 1.08-3.42; p = 0.03). It was a retrospective study, so we started in 2015 a prospective study to identify the frequency of these polymorphisms in smokers who looks for smoking cessation programs. Methods We collected data and blood sample from 127 smokers (october 2015 to december 2016) to investigate Bupropion CYP2B6 rs2279343 and Varenicline CHRNA4 rs1044396 polimorphisms. Results The average of age was 50 + 9 (20 -74 years), 80% caucasian, 14% afro descend, 6% yellow. The polymorphism favoring Bupropion (AA) was found in 58.2% (74) and favoring to varenicline (CT and TT) in 70% of the sample (89). Important to say that 42 participant had both polymorphisms favoring to varenicline and to Bupropion (33%).Only 12 smokers presented both unfavorable polymorphisms to any of these drugs. Conclusions The prospect of choosing the drug based on this finding may have a relevant economic impact, eventhough trials shows that varenicline is more efective than bupropion, Bupropion is cheaper than varenicline. We already started a randomized trial to test the cost-effectiveness of this hypothesis

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present