Quarterly Focus Issue: Prevention/Outcomes
Coronary Disease Risk
Cardiovascular Effect of Bans on Smoking in Public Places: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.jacc.2009.07.022Get rights and content
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Objectives

A systematic review and a meta-analysis were performed to determine the association between public smoking bans and risk for hospital admission for acute myocardial infarction (AMI).

Background

Secondhand smoke (SHS) is associated with a 30% increase in risk of AMI, which might be reduced by prohibiting smoking in work and public places.

Methods

PubMed, EMBASE, and Google Scholar databases plus bibliographies of relevant studies and reviews were searched for peer-reviewed original articles published from January 1, 2004, through April 30, 2009, using the search terms “smoking ban” and “heart” or “myocardial infarct.” Investigators supplied additional data. All published peer-reviewed original studies identified were included. Incidence rates of AMI per 100,000 person-years before and after implementation of the smoking bans and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. Random effects meta-analyses estimated the overall effect of the smoking bans. Funnel plot and meta-regression assessed heterogeneity among studies.

Results

Using 11 reports from 10 study locations, AMI risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation.

Conclusions

Smoking bans in public places and workplaces are significantly associated with a reduction in AMI incidence, particularly if enforced over several years.

Key Words

smoking
myocardial infarct
public health
secondhand smoke
incidence

Abbreviations and Acronyms

ACS
acute coronary syndrome
AMI
acute myocardial infarction
CI
confidence interval
ICD
International Classification of Diseases
IRR
incidence rate ratio
SHS
secondhand smoke

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