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Comparison of case fatality in smokers and non-smokers after acute cardiac event

BMJ 1997; 315 doi: (Published 18 October 1997) Cite this as: BMJ 1997;315:992
  1. Gabe S Sonke, postgraduate studenta,
  2. Alistair W Stewart, biostatisticiana,
  3. Robert Beaglehole (, professora,
  4. Rod Jackson, associate professora,
  5. Harvey D White, cardiologistb
  1. a Department of Community Health, Faculty of Medicine and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
  2. b Department of Cardiology, Green Lane Hospital, Auckland,
  1. Correspondence to: Professor Beaglehole
  • Accepted 25 April 1997


Although smoking is a major modifiable risk factor for acute myocardial infarction, it has also been associated with an up to twofold lower risk of dying in hospital after an acute myocardial infarction.1 2 We analysed data from a community based register of coronary heart disease to determine whether differences in case fatality (the proportion of those dying) between smokers and non-smokers are restricted to patients who have been admitted to hospital and to evaluate possible explanations for this smoker's paradox.

Subjects, methods, and results

All deaths related to coronary causes and all admitted patients aged 25–64 who met predefined criteria for myocardial infarction or coronary death were identified in Auckland, New Zealand, between 1986 and 1992 as part of the World Health Organisation MONICA (monitoring trends and determinants in cardiovascular disease) project. Study criteria, and methods of case finding and …

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