Cardiovascular Effect of Bans on Smoking in Public Places
A Systematic Review and Meta-Analysis
David G. Meyers, MD, MPH*,{dagger},*, John S. Neuberger, DrPH, MPH, MBA{dagger} and Jianghua He, PhD{ddagger}

* Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
{dagger} Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas
{ddagger} 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@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.