European Heart Studies

Cox, B.; Vangronsveld, J.; Nawrot, T.S., "Impact of stepwise introduction of smoke-free legislation on population rates of acute myocardial infarction deaths in Flanders, Belgium," Heart 100(18): 1430-1435, September 15, 2014.

This study published in the journal Heart noted that smokefree legislation in Belgium was implemented in phases, permitting the authors "the opportunity to investigate possible stepwise changes in fatal acute myocardial infarction (AMI) rates." The authors concluded that, "Smoking ban interventions are associated with reductions in the population rate of myocardial mortality, with public health gains even before and during the middle-aged period of life."

Christensen, T.M.; Moller, L.; Jorgensen, T.; Pisinger, C., "The impact of the Danish smoking ban on hospital admissions for acute myocardial infarction," European Journal of Preventive Cardiology [Epub ahead of print], August 31, 2012.

This study examined the impact of the nation's smokefree air law on heart attack rates and concluded that, "A significant reduction in the number of AMI-admissions was found already one year before the SB [smoking ban] after adjustment for the incidence of T2D [type 2 diabetes]. The results differ from most results found in similar studies throughout the world and may be explained by the incremental enactment of SBs in Denmark and the implementation of a nation-wide ban on industrially produced trans-fatty acids in food in 2004."

Seguret, F.; Ferreira, C.; Cambou, J.P.; Carriere, I.; Thomas, D., "Changes in hospitalization rates for acute coronary syndrome after a two-phase comprehensive smoking ban," European Journal of Preventive Cardiology [Epub ahead of print], August 5, 2013.
The authors wote, "This study did not demonstrate a significant effect of a two-phases smoking ban on ACS hospitalization rate. A steadily decrease of this rate over the 7-year period, the past preventive measures in France leading to low levels of passive smoking, and the significant increase in active smoking during the studied period may explain this result. Our study highlights the difficulty of proving an effect of smoking bans in a country with an already low ACS incidence."
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According to an article published in ScienceDaily Magazine, "French researchers announced a striking 15% decrease in admissions of patients with myocardial infarction to emergency wards since the public ban on smoking came into effect in restaurants, hotels and casinos in France last January."

Professor Davis Thomas, of the European Society of Cardiology and a Senior Cardiologist in the Centre Hospitalier Pitié- Salpêtrière in Paris, stated, "Although further studies are needed all over France to confirm the strong decrease in smoking related deaths over time, these statistics show the same tendency professionals have already observed in Italy, Ireland and Scotland when these countries introduced their own bans on tobacco. To me, the most striking aspect in this study is the reduction of pollution inside cafés and restaurants by over 35%. Passive smoking has been shown to increase the risk of coronary heart disease and the recent smoking ban is obviously having a beneficial effect on both smokers and non-smokers."

Schmucker, J.; Wienbergen, H.; Seide, S.; Fiehn, E.; Fach, A.; Wurmann-Busch, B.; Gohlke, H.; Gunther, K.; Ahrens, W.; Hambrecht, R., "Smoking ban in public areas is associated with a reduced incidence of hospital admissions due to ST-elevation myocardial infarctions in non-smokers: results trom the BREMEN STEMI REGISTRY," European Journal of Preventive Cardiology [Epub ahead of print], April 30, 2013.

In April 2013, a study published in the European Journal of Preventive Cardiology compared heart attack rates in Bremen, Germany, before and after the late 2007 implementation of a smokefree air law. The study concluded that, "...a significant decline of hospital admissions due to STEMIs in non-smokers was observed after the smoking ban in public areas came into force. No reduction of STEMI-related admissions was found in smokers. These results may be explained by the protection of non-smokers from passive smoking and the absence of such an effect in smokers by the dominant effect of active smoking."

Sargent, J.D.; Demidenko, E.; Malenka, D.J.; Li, Z.; Gohlke, H.; Hanewinkel, R., "Smoking restrictions and hospitalization for acute coronary events in Germany," Clinical Research in Cardiology 101(3): 227-235, 2012.
In 2012, a study published in Clinical Research in Cardiology, concluded that, "Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany."
Heidrich, J.; Wellmann, J.; Heuschmann, P.U.; Kraywinkel, K.; Keil, U., "Mortality and morbidity from coronary heart disease attributable to passive smoking," European Heart Journal [Epub ahead of print], May 15, 2007.
A study published online on May 15, 2007 in the European Heart Journal concluded "Using an evidence-based approach reveals a substantial burden of passive smoking in terms of CHD mortality and morbidity reflected by six CHD deaths and 10 incident CHD cases every day in Germany."
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On February 22, 2013, The Local reported that, "... Another study showed an 8.6-percent reduction in heart attacks generally, since the introduction during 2007 and 2008 of a ban on smoking in many public places. This was the conclusion of work conducted last year by the Kiel Institute for Therapy and Health Research based on data from the 3.7 million people insured by the DAK statutory insurer. Those bans, based on a law protecting employees from having to be in smoky workplaces, prevented more than 35,000 serious cardio-vascular illnesses, the study suggested. These would have cost around €150 million in treatment."
Panagiotakos, D.B.; Pitsavos, C.; Stefanadis, C., "Chronic exposure to second hand smoke and 30-day prognosis of patients hospitalised with acute coronary syndromes: the Greek study of acute coronary syndromes," Heart 93(3): 309-312, March 2007.

This study investigated the association between chronic exposure to second hand smoke (SHS) and the short-term prognosis of patients hospitalised with acute coronary syndromes and concluded that, "Exposure to SHS increases considerably the risk of recurrent events in patients who had survived a cardiac event."

Stallings-Smith, S.; Zeka, A.; Goodman, P.; Kabir, Z.; Clancy, L., "Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national Irish smoking ban: interrupted time-series analysis," PLOS ONE 8(4): e62063, April 24, 2013.

This study found that the smokefree air law in Ireland resulted in lower mortality overall and from heart disease, stroke, and chronic obstructive pulmonary disease (COPD). The abstract stated, "The national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes."

Cronin, E.M.; Kearney, P.M.; Kearney, P.P.; Sullivan, P.; Perry, I.J., "Impact of a national smoking ban on hospital admission for acute coronary syndromes: a longitudinal study," Clinical Cardiology [Epub ahead of print], January 25, 2012.

In January 2012, a study published in Clinical Cardiology concluded that the nation's smokefree air law had resulted in "an early significant decrease in hospital admissions" for acute coronary syndromes (ACS).

Richiardi, L.; Vizzini, L.; Merletti, F.; Barone-Adesi, F., "Cardiovascular benefits of smoking regulations: the effect of decreased exposure to passive smoking," Preventive Medicine 48(2): 167-172, February 2009.

This study estimated the probable decreases in acute myocardial infarction (AMI) due to implementation of a smokefree air law. The authors wrote that, "After evaluating several possible combinations of these parameters, we found that AMI reductions of 5-15% seem likely." They concluded that, "...our simulation-based estimates indicate that regulations banning smoking in public places can cause immediate and relevant decreases in AMI incidence in the population through prevention of exposure to passive smoking."

Vasselli, S.; Papini, P.; Gaelone, D.; Spizzichino, L.; De Campora, E.; Gnavi, R.; Saitto, C.; Binkin, N.; Laurendi, G., "Reduction incidence of myocardial infarction associated with a national legislative ban on smoking," Minerva Cardioangiologia 56(2): 197-203, April 2008.
This study concluded "that there has been an appreciable reduction in the incidence of heart attacks in the period immediately subsequent to the coming into force of the non-smoking law in the populations surveyed, and that this reduction mainly regards men of working age. The reduction reverses a trend that has been evident for a number of years, namely that of a decidedly upward trend in the number of admissions for AMI."
Cesaroni, G.; Forastiere, F.; Agabiti, N.; Valente, P.; Zuccaro, P., "Effect of the Italian smoking ban on population rates of acute coronary events," Circulation 117: 1183-1188, February 11, 2008.
This study found "a statistically significant reduction in acute coronary events in the adult population after the smoking ban. The size of the effect was consistent with the pollution reduction observed in indoor public places and with the known health effects of passive smoking."
Barone-Adesi, F.; Vizzini, L.; Merletti, F.; Richiardi, L., "Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction," European Heart Journal [Epub ahead of print], August 29, 2006.
This study examined hospital admissions for heart attacks in northern Italy in order to "to evaluate whether a national law banning smoking in public resulted in a short-term reduction in hospital admissions for acute myocardial infarction (AMI)." The authors concluded that, "Our study, based on a population of about 4 million inhabitants, suggests that smoke-free policies may result in a short-term reduction in admissions for AMI."

de Korte-de Boer, D.; Kotz, D.; Viechtbauer, W.; van Haren, E.; Grommen, D.; de Munter, M.; Coenen, H.; Gorgels, A.P.; van Schayck, O.C., "Effect of smoke-free legislation on the incidence of sudden circulatory arrest in the Netherlands," Heart 98(13): 995-999, July 2012.

This study concluded that, "After introduction of a nationwide workplace smoking ban in 2004, a significant decrease in the incidence of out-of-hospital SCA was seen in South Limburg. Poor enforcement of the 2008 hospitality sector ban may account for the fact that no further decrease in the incidence of SCA was seen at this time."

Fernández de Bobadilla, J.; Dalmau, R.; Galve, E., "Laws restricting smoking in public places reduce the incidence of acute coronary syndrome in Spain," Revista Espanola De Cardiologia 67(5): 349-352, May 2014.

This study examined the impact of smokefree legislation in Spain on incidence of acute coronary syndrome and concluded, "The ban on smoking in public places protects the population from passive exposure to smoke, mainly reducing the risk of tobacco for passive smokers and, specifically, cutting the incidence of ACS and its cost. It probably also reduces risk for active smokers, with the consequent reduction in the number of smokers and the mean number of cigarettes smoked per smoker. In Spain, over a period of 5 years, 2 laws have been passed that restrict tobacco use in public places; the second—and more restrictive— has enhanced the efficacy of the first."

Aguero, F.; Degano, I.R.; Subirana, I.; Grau, M.; Zamora, A.; Sala, J.; Ramos, R.; Tresseras, R.; Marrugat, J.; Elosua, R., "Impact of a partial smoke-free legislation on myocardial infarction incidence mortality and case-fatality in a population-based registry: the REGICOR Study," PLOS ONE, January 23, 2013.

This study assessed the impact of the partial smoke-free legislation passed in 2006 on the incidence of acute myocardial infarction in the province of Girona and observed it had dropped 11%. This decrease was noticed especially among women, population aged between 65 and 74, and among nonsmokers.

Villalbi, J.R.; Castillo, A.; Cleries, M.; Salto, E.; Sanchez, E.; Martinez, R.; Tresserras, R.; Vela, E., "Acute myocardial infarction hospitalization statistics: apparent decline accompanying an increase in smoke-free areas," Revista Espanola de Cardiologia 62(7): 812-815, July 2009.

This study from Spain analyzed heart attack rates in Barcelona after a smokefree law was implemented in 2006. The study found that, "...the introduction of regulations on smokefree areas was accompanied by a reduction in the AMI hospitalization rate." The authors made suggestions for further research.

Vicedo-Cabrera, A.M.; Röösli, M.; Radovanovic, D.; Grize, L.; Witassek, F.; Schindler, C.; Perez, L., "Cardiorespiratory hospitalisation and mortality reductions after smoking bans in Switzerland," Swiss Medical Weekly 46: w14381, December 19, 2016.
This study found that smokefree laws in Switzerland were associated with overall reductions in cardiovascular and respiratory hospitalisation and mortality in adults.
Rajkumar, S.; Schmidt-Trucksass, A.; Wellenius, G.A.; Bauer, G.F.; Huynh, C.K.; Moeller, A.; Roosli, M., "The effect of workplace smoking bans on heart rate variability and pulse wave velocity of non-smoking hospitality workers," International Journal of Public Health 59(4): 577-585, August 2014.

This study concluded that the implementation of a smokefree air law improved heart rate variability (HRV) and pulse wave velocity (PWV), "indicating a decreased cardiovascular risk" among non-smoking hospitality workers.

Di Valentino, M., "Reduction of ST-elevation myocardial infarction in Canton Ticino (Switzerland) after smoking bans in enclosed public places: no smoke pub study," European Journal of Public Health [Epub ahead of print], June 3, 2014.

This study assessed the impact of smokefree legislation on heart attacks in Canton Ticino and concluded that, "Our work suggests a significant impact of the smoke-free policy on the number of annual STEMI. Specific population subsets (i.e. =65-year-old females) were particularly affected by the smoking ban, showing a significant reduction in STEMI hospitalizations."

Humair, J.P.; Garin, N.; Gerstel, E.; Carballo, S.; Carballo, D.; Keller, P.F.; Guessous, I., "Acute respiratory and cardiovascular admissions after a public smoking ban in Geneva, Switzerland," PLOS ONE 9(3): e90417, March 2014.

This study examined the impact of a phased-in smokefree law in Geneva, Switzerland, on hospitalizations for "acute coronary syndrome, ischemic stroke, acute exacerbation of chronic obstructive pulmonary disease, pneumonia and acute asthma." The authors concluded that, "A legislative smoking ban was followed by a strong decrease in hospitalisations for acute exacerbation of chronic obstructive pulmonary disease and a trend for reduced admissions for acute coronary syndrome."

Bonetti, P.O.; Trachsel, L.D.; Kuhn, M.U.; Schulzki, T.; Erne, P.; Radovanovic, D.; Reinhart, W.H., "Incidence of acute myocardial infarction after implementation of a public smoking ban in Graubünden, Switzerland: two year follow-up," Swiss Medical Weekly [Epub ahead of print], May 27, 2011.

In 2011, a follow-up study to an earlier paper published in Swiss Medical Weekly (see below), concluded that hospital admissions for acute myocardial infarction (AMI) fell 21% in the two years following implementation of the smokefree law in Graubünden, when compared to the two years prior. The researchers also found that changes in outdoor air quality or the use of lipid-lowering drugs did not substantially contribute to the decrease in the incidence of AMI.

Trachsel, L.D.; Kuhn, M.U.; Reinhart, W.H.; Schulzki, T.; Bonetti, P.O., "Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland," Swiss Medical Weekly, 140(9-10): 133-138, 2010.

A study published in 2010 in the Swiss Medical Weekly found that a smokefree law in the Canton of Graubünden, Switzerland, resulted in fewer heart attacks in the first year after its implementation. The law took effect on March 1, 2008. In the first year following its implementation, there was an overall 22% reduction in incidences of acute myocardial infarction (AMI).