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| Heart Attacks Decreased After Public Smoking Ban In Italy |
Heart Attacks Decreased After Public Smoking Ban In Italyeg
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
ig/m3 before the ban to 43 ig/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.
"The
older age group spends more time at home than in the workplace or
public businesses," said Giulia Cesaroni, M.Sc., senior researcher at
the Department of Epidemiology, Rome, Italy. "The smoking ban has a
greater effect on those of working age and those who spend a lot of
their time in public places."
Young people living in low
socioeconomic areas seemed to have the greatest reduction in acute
coronary events after the smoking ban, researchers reported. Those
living in lower socioeconomic areas have worse health conditions with
more risk factors for heart attack such as obesity, hypertension,
diabetes and a higher rate of active smoking.
"This implies that a
disadvantaged person has a higher probability of being surrounded by
smokers at work and in public places unless a smoking ban is in place,"
Cesaroni said.
The researchers said the health benefits seen in this
study probably result from a significant reduction in exposure to
passive smoking. In addition, a smoking-free environment makes it
easier for smokers to stop smoking.
"Since coronary heart disease is
a leading cause of death in Italy, the reduction observed had enormous
public health implications," Forastiere said. "It will be interesting
to see if the effect of the ban is stable over time and if similar
positive health effects can be detected in other places.
"While the
trend is to implement smoking bans, there are still areas in the world
such as some European countries, Asia, and America where smoking in
public places is an important public health issue. Smoking bans should
be extended to all possible countries and smoking bans in the workplace
should be strongly enforced."
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