United States Heart Studies

This page contains information on U.S.-based studies documenting the impact of smokefree air laws on heart attack rates. The page is arranged with national and/or regional studies first, and then alphabetically by state.

United States
Vander Weg, M.W.; Rosenthal, G.E.; Vaughan Sarrazin, M., "Smoking bans linked to lower hospitalizations for heart attacks and lung disease among Medicare beneficiaries," Health Affairs 31(12): 2699-2707, December 2012.

This study "investigated the association between smoking bans targeting workplaces, restaurants, and bars passed throughout the United States during 1991–2008 and hospital admissions for smoking-related illnesses—acute myocardial infarction and chronic obstructive pulmonary disease—among Medicare beneficiaries age sixty-five or older." The study concluded that, "Risk-adjusted hospital admission rates for acute myocardial infarction fell 20–21 percent thirty-six months following implementation of new restaurant, bar, and workplace smoking bans."

Lippert, W.C.; Gustat, J., "Clean Indoor Air Acts reduce the burden of adverse cardiovascular disease," Public Health 126(4): 279-285, April 2012.

This study examined the impact of clean indoor air acts (CIAAs) on acute myocardial infarction (AMI) and coronary heart disease (CHD) in seventeen U.S. states/territories by comparing the prevalence of self-reported health outcomes one year prior to implementation and one year after. The authors stated that, "State/territory-wide CIAAs are beneficial in reducing adverse cardiovascular health outcomes in the short term. The prevalence of AMI, CHD/angina, and former and current smokers decreased significantly following CIAA implementation. The current study adds further support for the passage and implementation of CIAAs on a state/territory-wide level." The authors recommended further studies to assess the long-term outcomes of smokefree laws.

Herman, P.M.; Walsh, M.E., "Hospital admissions for acute myocardial infarction, angina, stroke, and asthma after implementation of Arizona's comprehensive statewide smoking ban," American Journal of Public Health 101(3): 491-496, March 2011.

This study examined the impact of Arizona's smokefree air law on hospital admissions for heart attacks, angina, stroke, and asthma. The study found that the smokefree law resulted in a statistically significant decrease in all four conditions. The reductions were larger for counties without pre-existing smokefree ordinances than for counties with pre-existing smokefree laws. The authors wrote that, "...there is evidence that the following reductions (and percentage reductions) in hospital admission cases in the nonban counties from May 1, 2007, to May 31, 2008, are attributable to the statewide ban:159 (13%) fewer AMI cases, 63 (33%) fewer angina cases, 198 (14%) fewer stroke cases, and 249 (22%) fewer asthma cases. The estimated savings in hospital costs from these reductions is $16.8 million. These estimates may underestimate the impact of the statewide ban in these counties because they are estimates of reductions in admissions in addition to what could have been expected in ban counties." The authors recommended the implementation of smokefree air laws to "improve health care and reduce health care costs."

Colorado (Statewide)
Basel, P.; Bartelson, B.B.; Le Lait, M.C.; Krantz, M.J., "The effect of a statewide smoking ordinance on acute myocardial infarction rates," American Journal of Medicine 127(1): 94-96, January 2014.

This study concluded that, "Although local smoking ordinances in Colorado previously suggested a reduction in acute myocardial infarction hospitalizations, no significant impact of smoke-free legislation was demonstrated at the state level, even after accounting for preexisting ordinances."

Colorado (City of Greeley)
Bruintjes, G.; Bucher Bartelson, B.; Hurst, P.; Levinson, A.H.; Hokanson, J.E.; Krantz, M.J., "Reduction in acute myocardial infarction hospitalization after implementation of a smoking ordinance," American Journal of Medicine 124(7): 647-654, July 2011.

This study examined the impact of Greeley, Colorado's smokefree ordinance on hospital admissions for acute myocardial infarction. The authors found a reduction in heart attacks of 27 percent overall, with a greater reduction among smokers than among nonsmokers, and noted that, "a smoking ordinance in Greeley, Colorado was associated with a significant decrease in acute myocardial infarction hospitalizations of a magnitude identical to ordinance enactment in Pueblo, Colorado. No differential impact on type of myocardial infarction was noted. In contrast to prior studies, the reduction in acute coronary events was magnified among smokers. Like all prior studies, the current analysis demonstrates only an association between an ordinance and acute myocardial infarction incidence rates. A causal relationship cannot be proven, given the possibility of unmeasured confounding and secular trends."

Colorado (City of Pueblo)
Bartecchi, C.; Alsever, R.N.; Nevin-Woods, C.; Thomas, W.M.; Estacio, R.O.; Bartelson, B.B.; Krantz, M.J., "Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance," Circulation, 114: 1490-1496, 2006.
Alsever, R.N.; Thomas, W.M.; Nevin-Woods, C.; Beauvais, R.; Dennison, S.; Bueno, R.; Chang, L.; Bartecchi, C.E.; Babb, S.; Trosclair, A.; Engstrom, M.; Pechacek, T.; Kaufmann, R., "Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance - City of Pueblo, Colorado, 2002-2006," Morbidity and Mortality Weekly Report 57(51 & 52): 1373-1377, January 2, 2009.

On November 14, 2005, a new study was presented at the American Heart Association's Scientific Sessions conference, which found that heart attack rates in Pueblo, Colorado, dropped by nearly 30 percent after the city passed a smokefree ordinance in 2003. According to a press release issued by the Pueblo City-County Health Department, "The Pueblo study affirmed that such laws can cause a dramatic improvement in public health, within even the first few months."

In October 2006, the study was published in the journal Circuation.

On January 2, 2009, a follow-up study was published in the journal Morbidity and Mortality Weekly Report. The study found that heart attack rates in Pueblo continued to decline.

Related Material:

Smoking Bans Prevent Heart Attacks (Editorial)
Jonathan M. Samet, MD, MS
Circulation, October 2006

Pueblo Heart Study Fact Sheet (2005)

Seo, D.; Torabi, M.R., "Reduced admissions for acute myocardial infarction associated with a public smoking ban: matched controlled study," Journal of Drug Education 37(3): 217-226, 2007.

A study by Indiana University researchers found that comprehensive smokefree workplace laws result in immediate and significant improvements in heart health, particularly in nonsmokers.

The study found a 59% net decrease in hospital admissions for heart attacks, also known as acute myocardial infarctions (AMIs), in nonsmokers with no prior cardiac history in Monroe County, Indiana versus the control county during the study period which tracked 22 months prior to and following the implementation of a comprehensive smokefree workplace law.

ANR Press Release


On January 14, 2010, the American Cancer Society announced the completion of a study into the effect of the 2008 Iowa Smokefree Air Act on hospital admissions for tobacco related conditions.

The study examined data submitted to the Iowa Department of Public Health summarizing the number of monthly hospitalizations between July 2005 and June 2009 for cardiovascular diseases caused or made worse by smoking and exposure to tobacco smoke.

“We found a 24 percent reduction in hospital admissions due to coronary heart disease in the year after the Smokefree Air Act was passed compared with the previous three years,” said Dr. Christopher Squier of the Department of Oral Pathology at the College of Dentistry, University of Iowa. “This represents 2,324 fewer Iowans dealing with this condition, a result that no one can ignore. In less than two years, we are already seeing the public health benefits of this landmark piece of legislation, and for that our legislators and the governor should be commended.”

Hospital admissions due to heart attacks and strokes were also down during this same period.

Kentucky (City of Lexington)
Hahn, E.J.; Burkhart, P.V.; Moser, D.K., "Smoke-free laws, gender, and reduction in hospitalizations for acute myocardial infarction," Public Health Reports 126(6): 826-833, November/December, 2011.

This study found that women in Lexington, Kentucky, had 23 percent fewer Acute Myocardial Infarction (AMI) hospitalizations after the city adopted a smokefree ordinance. The rate among men did not change significantly. It was noted that there was an over-representation of women in the hospitality industry.

Dove, M.S.; Dockery, D.W.; Mittleman, M.A.; Schwartz, J.; Sullivan, E.M.; Keithly, L.; Land, T., "The impact of Massachusetts' smoke-free workplace laws on acute myocardial infarction deaths," American Journal of Public Health 100(11): 2206–2212, November 2010

A study published in the November 2010 issue of the American Journal of Public Health stated that, "Comprehensive statewide smoke-free workplace laws in Massachusetts were associated with an estimated 270 fewer AMI deaths per year. These results add to the evidence suggesting that smoke-free air laws are associated with lower rates of AMI."

According to a November 12, 2008 Boston Globe article, a study conducted by the state Department of Public Health and the Harvard School of Public Health has found that the state's smokefree air law had resulted in a decrease heart attacks.

The article stated that, "the number of heart attacks began dropping in communities with strong antismoking laws years before the 2004 statewide law and that similar reductions were achieved in other cities and towns only after the state ban. By the end of 2006, the rate of decline in all cities and towns had nearly converged. The authors said this pattern showed that advances in treatment of heart attacks were not responsible for the smaller number of deaths."


A 2008 study conducted by the Henry Ford Hospital concluded that the number of heart attacks in Michigan could be significantly reduced if a statewide smokefree air law were passed.

Mouaz Al-Mallah, M.D., Henry Ford's director of Cardiac Imaging Research and lead author of the study, stated, "If Michigan were to implement a comprehensive smoking ban tomorrow, we would see a 12 percent drop in heart attack admissions after the first year."

Hurt, R.D.; Weston, S.A.; Ebbert, J.O.; McNallan, S.M.; Croghan, I.T.; Schroeder, D.R.; Roger, V.L., "Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws," Archives of Internal Medicine [Epub ahead of print], October 29, 2012.

This study examined the impact on heart attacks of a smokefree restaurant ordinance implemented in Olmsted County, Minnesota, in 2002, and the impact when the ordinance was expanded n 2007, so that all workplaces, including bars, became smokefree. The study found that, "Comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI [myocardial infarction] declined by 33%." The authors of the study wrote, "A substantial decline in the incidence of MI was observed after smoke-free laws were implemented, the magnitude of which is not explained by community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke."


A study presented at the fall 2011 American Heart Association’s Scientific Sessions found that "the incidence of heart attacks and sudden cardiac deaths have decreased since the implementation of comprehensive smoke-free laws in Olmsted County, Minn., in 2002." The study measured heart attack rates before and after the smokefree ordinance took effect and found a 45 percent decrease in incidence of heart attacks in the 18 months following implementation.

Montana (City of Helena)
Sargent, R.P.; Shepard, R.M.; Glantz, S.A., "Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study," BMJ Online First, April 5, 2004.

The city of Helena, Montana, enacted a smokefree air law in June 2001, bringing smokefree air to all indoor workplaces, including restaurants and bars. The law was in effect for six months starting in June 2002 before it was suspended due to a legal challenge. During those six months, a significant trend was observed at the regional hospital. The rate of heart attacks in the Helena area declined by 40% while the smokefree air law was in effect, and then increased once the law was suspended.

Dr. Richard P. Sargent announced these findings on April 1, 2003 at the American Conference of Cardiology. Dr. Sargent , Dr. Robert Shepard and Dr. Stanton Glantz conducted a study to compare the number of hospital admissions in Helena for acute myocardial infarctions (heart attacks) during the sixth month period the smokefree workplace law was in effect, and compared those numbers to the same time period in the previous four years, and looked at figures for the surrounding area not affected by the smokefree law.

The Helena study, "Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study," was published in the April 2004 issue of the British Medical Journal. The doctors found a 40% drop in admissions for heart attacks from people living or working in Helena - where a smokefree ordinance was in effect - and no change for people living further away. The study shows that the health benefits of a comprehensive smokefree workplace law may be much more immediate than previously thought.

In response to the findings of the Helena study, the CDC has issued a warning that people at risk of heart disease should avoid exposure to secondhand smoke due to the immediate affects secondhand smoke can have in indoor places that allow smoking. The CDC warning is very significant because it is the first time a government agency has taken action to publicize the acute affects of secondhand smoke and its imminent harm to the public.

Dr. Sargent and Dr. Shepard were the recipients of the first annual Americans for Nonsmokers' Rights Smokefree Advocate of the Year Award in recognition of their leadership in protecting nonsmokers from secondhand smoke, and their work conducting the landmark cardiology study in Helena. The awards were presented on December 10, 2003 at the National Conference on Tobacco or Health in Boston, MA.

The Helena Heart Study demonstrates that even a little exposure to secondhand smoke can be deadly. The study is powerful, and demonstrated the urgent need for smokefree laws to protect the public. So it comes as no surprise that the Helena Heart study has unfairly come under attack by the opposition. The opposition has used unsubstantiated claims to argue the validity of this study. These claims are hogwash. If the study is challenged in your community, this Helena heart study fact sheet from the American Heart Association may be an helpful resource.

Related Material:

Talking Points on the Helena Heart Study

American Heart Association Press Release (misdated)

New York
Juster, H.R.; Loomis, B.R.; Hinman, T.M.; Farrelly, M.C.; Hyland, A.; Bauer, U.E.; Birkhead, G.S., "Declines in hospital admissions for acute myocardial infarction in New York State after implementation of a comprehensive smoking ban," American Journal of Public Health 97(11): 2035–2039, November 2007.

This study found that the New York state's smokefree air law resulted in 3,813 fewer hosptial admissions for heart attacks in 2004, as well as a savings of $56 million in direct health care costs.

North Carolina
[n.a.], "The North Carolina smoke free restaurants and bars law and emergency department admissions for acute myocardial infarction: a report to the North Carolina State Health Director," NC Tobacco Prevention and Control Branch Epidemiology and Evaluation Unit, 2011.

This study from North Carolina examined hospital admissions for heart attacks and stated, "Results from this analysis suggest that, from 2008 to 2010, the rate of ED visits for AMI in North Carolina decreased. While it is impossible to tease out the exact magnitude of effect of the N.C. Restaurants and Bars Law, it is likely that it contributed to this decline."

North Dakota (City of Grand Forks)
Johnson, E.L.; Beal, J.R., "Impact of a comprehensive smoke-free law following a partial smoke-free law on incidence of heart attacks at a rural community hospital," Nicotine and Tobacco Research 15(3): 745-747, March 2013.

This study from Grand Forks, North Dakota, and found that "an implementation of the comprehensive smoke-free law was associated with a decrease in the heart attack rate. The heart attack rate decreased 30.6%. Our finding was similar to previous community level smoke-free law implementation studies and notable for the change going from a partial smoke-free law to a comprehensive smoke- free law."

Ohio (City of Bowling Green)
Khuder, S.A.; Milz, S.; Jordan, T.; Price, J.; Silvestri, K.; Butler, P., "The impact of a smoking ban on hospital admissions for coronary heart disease," Preventive Medicine 45(1): 3-8, July 2007.

In March 2002, the city of Bowling Green, Ohio, implemented a smokefree ordinance in workplaces and public places.

The study examined the effect of the ordinance on hospital admissions for smoking-related diseases and concluded that, "A reduction in admission rates for smoking-related diseases was achieved in Bowling Green compared to the control city. The largest reduction was for coronary heart disease, where rates were decreased significantly by 39% after 1 year and by 47% after 3 years following the implementation of the ordinance."

Rhode Island
Roberts, C.; Davis, P.J.; Pearlman, D.N.; Taylor, K.E., "The impact of Rhode Island's statewide smoke-free ordinance on hospital admissions and costs for acute myocardial infarction and asthma," Health by Numbers 95(1): 23-25, 2012.

This Rhode Island study found a 28.4 percent drop in the rate of acute myocardial infarction (AMI) hospital admissions and a 14.6 percent drop in the total associated cost of treatment four years after the state adopted a clean indoor air law. The declines represented a potential savings of over six million dollars.

Texas (City of Beaumont)
Head, P.; Jackson, B.E.; Bae, S.; Cherry, D., "Hospital discharge rates before and after implementation of a city-wide smoking ban in a Texas city, 2004-2008," Preventing Chronic Disease E179, December 2012.

This study found that hospital discharge rates in Beaumont, Texas, declined significantly for blacks, whites, and both races combined for acute myocardial infarction, stroke or cerebrovascular accident, chronic obstructive pulmonary disease, and asthma following implementation of a smokefree ordinance.

West Virginia (Kanahwa County)
Gupta, R.; Luo, J.; Anderson, R.H.; Ray, A., "Clean indoor air regulation and incidence of hospital admissions for acute coronary syndrome in Kanawha County, West Virginia," Preventing Chronic Disease Public Health Research, Practice, and Policy 8(4): A77, July 2011.

This study from Kanawha County, West Virginia, examined hospital admissions data for acute coronary syndrome (ACS) and acute myocardial infarction (AMI) from 2000 through 2008. The county had enacted its original clean indoor air ordinance in 1995 and revised it in 2000 and 2003. The authors found that, "The incidence of hospital admissions for ACS consistently declined during the period studied. This change was most pronounced among nonsmokers, people without diabetes, and women, compared with their respective counterparts. Similar benefits occurred for male smokers when the CIAR was revised to make restaurants completely smoke-free in 2004."