Smoking Bans Boost Heart Health

Anti-smoking laws reduced risks of hospitalization and death for smoking-related cardiovascular and lung diseases, with the most comprehensive laws having the biggest impact on hospitalizations and deaths, according to a meta-analysis.

Comprehensive smoke-free legislation was associated with a significant reduction in admissions or death for four disease groups: acute coronary events, cerebrovascular events, respiratory disease, and other heart disease, within a median 24 months of enacting the laws, according to Stanton Glantz, PhD, and Crystal Tan, MS, both of the University of California San Francisco.

The more comprehensive a law was, the more likely areas serviced by it would see reductions in hospital admissions by individual outcomes (P=0.001) and by disease group (P=0.002), they wrote online Oct 29 in the journal Circulation: Journal of the American Heart Association.

Researchers also found no difference between men and women in the reduction of acute MI following enactment of smoke-free laws of variable comprehensiveness.

The researchers analyzed 43 studies evaluating hospitalizations or deaths for smoking-related illness in areas with or without anti-smoking laws, or comparing rates before and after a law was introduced. The studies covered 33 smoke-free laws.

Smoking-related illnesses included acute myocardial infarction, acute coronary syndrome, acute coronary events, ischemic heart disease, angina, coronary heart disease, sudden cardiac death, stroke, transient ischemic attack, chronic obstructive pulmonary disease, asthma, lung infections, and spontaneous pneumothorax.

Anti-smoking laws reduced risks of hospitalization and death for smoking-related cardiovascular and lung diseases such as acute MI and asthma, with the most comprehensive laws having the biggest impact on hospitalizations and deaths.

Point out that the laws did not significantly reduce hospitalizations for transient ischemic attack, chronic obstructive pulmonary disease, or spontaneous pneumothorax.

Glantz and Tan also measured whether comprehensiveness of a law was associated with stronger reductions in risk through a random effects meta-regression analysis. Comprehensiveness of a law was established by whether it affected workplaces only; workplaces and restaurants; or workplaces, restaurants, and bars.

For the four disease groups, the relative risk reductions for hospital admission or death associated with comprehensive anti-smoking laws were:

RR 0.84 (95% CI 0.81 to 0.88) for acute coronary events
RR 0.84 (95% CI 0.75 to 0.93) for cerebrovascular accidents
RR 0.76 (95% CI 0.68 to 0.84) for respiratory diseases
RR 0.61 (95% CI 0.44 to 0.84) for other heart disease