The number of acute coronary events such as heart attack in adults dropped significantly after a smoking ban in public places in Italy, researchers reported in Circulation: Journal of the American Heart Association.
Researchers in Rome compared acute coronary events in the city for five years preceding a public smoking ban with those occurring one year after the ban. They found an 11.2 percent reduction of acute coronary events in persons 35 to 64 years and a 7.9 percent reduction in those ages 65 to 74.
“Smoking bans in all public and workplaces result in an important reduction of acute coronary events,” said Francesco Forastiere, M.D., Ph.D., co-author of the study and head of the Environmental and Occupational Epidemiology Unit, Department of Epidemiology, Rome E. Health Authority, Italy. “The smoking ban in Italy is working and having a real protective effect on population health.”
The study was the first in Europe to show long-term health benefits of smoking bans in public places. It also was the first to consider in detail other factors such as temperature, air pollution, flu epidemics and time trends that affect acute coronary events such as heart attack.
The January 2005 comprehensive smoking ban in Italy included strong sanctions for smokers, businesses and workplace owners and managers. The prohibition included all indoor public places such as offices, retail shops, restaurants, pubs and discos.
Researchers compared the rate of acute coronary events from 2000 to 2004 to those occurring in 2005 after the ban was enforced.
Researchers identified acute coronary events from hospital discharge reports with a diagnosis of myocardial infarction or unstable angina and from the regional register of causes of deaths with diagnosis of out-of-hospital coronary deaths. The analysis was divided into three age groups: 35–64, 65–74 and 75–84 years. Researchers collected daily data on particulate matter in 40 public places and from four fixed monitors in residential areas together with temperature readings.
The indoor concentration of fine particles decreased significantly from a mean level of 119 ìg/m3 before the ban to 43 ìg/m3 one year after the ban.
During the period of the study there were changes in smoking habits such as:
- Frequency of smoking decreased from 34.9 percent to 30.5 percent in men and from 20.6 percent to 20.4 percent in women.
- Cigarette sales decreased 5.5 percent.
While the ban resulted in a significant reduction in acute coronary events in the two younger age groups, the older group (aged 75-84 years) showed no reduction.
When the researchers adjusted for time trends and all-cause hospitalization, the results remained statistically significant in the youngest group and in the 65–74 age group. This effect was only slightly reduced when the researchers compared the post-smoking ban data of 2005 to that from 2004.