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QUARTERLY FOCUS ISSUE: PREVENTION/OUTCOMES: CORONARY DISEASE RISK

Cardiovascular Effect of Bans on Smoking in Public Places

A Systematic Review and Meta-Analysis

David G. Meyers, MD, MPH^_*,,_*, John S. Neuberger, DrPH, MPH, MBA and Jianghua He, PhD

^_* Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas
Department of Biostatistics, University of Kansas School of Medicine, Kansas City, Kansas

Manuscript received May 13, 2009; revised manuscript received July 20, 2009, accepted July 28, 2009.

^_* Reprint requests and correspondence: Dr. David G. Meyers, Division of Cardiovascular Diseases, Kansas University School of Medicine, 3901 Rainbow Boulevard, Kansas City, Kansas 66160 (Email: dmeyers{at}kumc.edu).

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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