Effect of the Italian Smoking Ban on Population Rates of Acute Coronary Events

Abstract

Background-Several countries in the world have not yet prohibited smoking in public places. Few studies have been conducted on the effects of smoking bans on cardiac health. We evaluated changes in the frequency of acute coronary events in Rome, Italy, after the introduction of legislation that banned smoking in all indoor public places in January 2005. Methods and Results-We analyzed acute coronary events (out-of-hospital deaths and hospital admissions) between 2000 and 2005 in city residents 35 to 84 years of age. We computed annual standardized rates and estimated rate ratios by comparing the data from prelegislation (2000 -2004) and postlegislation (2005) periods. We took into account several time-related potential confounders, including particulate matter (PM 10 ) air pollution, temperature, influenza epidemics, time trends, and total hospitalization rates. The reduction in acute coronary events was statistically significant in 35-to 64-year-olds (11.2%, 95% CI 6.9% to 15.3%) and in 65-to 74-year-olds (7.9%, 95% CI 3.4% to 12.2%) after the smoking ban. No evidence was found of an effect among the very elderly. The reduction tended to be greater in men and among lower socioeconomic groups. Conclusions-We found a statistically significant reduction in acute coronary events in the adult population after the smoking ban. The size of the effect was consistent with the pollution reduction observed in indoor public places and with the known health effects of passive smoking. The results affirm that public interventions that prohibit smoking can have enormous public health implications.

Meta-analysis of the effects of smokefree laws on acute myocardial infarction: An update

“…The fact that the studies from Italy (Barone-Adesi et al, 2006;Cesaroni et al, 2008) and Ireland showed smaller drops in AMI admissions than in the American locations may reflect lower levels of compliance with the law than in the US. In Italy and Ireland, implementation of the law was associated with 64% (Valente et al, 2007) and 69% (Mulcahy et al, 2005) reductions, respectively, in levels of secondhand smoke exposure, compared to an 84% reduction in the US (Travers et al, 2004).…”

“…Summary of studies of the effects of smokefree laws on acute myocardial infarction in Helena, Montana (Sargent et al, 2004), Pueblo, Colorado (Bartecchi et al, 2006), Piedmont, Italy (Barone-Adesi et al, 2006), Bowling Green, Ohio (Khuder et al, 2007), New York State (Juster et al, 2007), Ireland (Cronin et al, 2007), Saskatoon, Canada (Lemstra, Neudorf and Opondo 2008), and Rome, Italy (Cesaroni et al, 2008).…”

Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions

“…6 A growing number of studies has shown evidence of reductions ranging from 8% to 40% in admissions to hospital for acute myocardial infarction after introduction of smoke-free legislation. [7][8][9][10][11][12][13] Very few studies have examined the impact of anti-smoking legislation on other cardiovascular outcomes or on respiratory outcomes.…”

Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

“…The introduction of legislation that prohibits smoking in indoor public spaces leads to an immediate reduction in inhalation of second-hand smoke by non-smokers, encourages smokers to attempt to quit smoking 1 , and reduces the prevalence of smoking 2,3 . Smoking ban legislation has been shown to lead to an immediate and significant reduction in acute myocardial infarction (AMI) risk in a number of studies [2][3][4][5][6][7][8][9][10][11] .…”