Abstract
BackgroundComprehensive smoke-free legislation has been implemented in many countries. The current study quantitatively examined the reduction in risk of acute myocardial infarction (MI) occurrence following the legislations and the relationship with the corresponding smoking prevalence decrease.MethodsPubMed, EMBASE, and Google Scholar databases and bibliographies of relevant studies and reviews were searched for potential original studies published from January 1, 2004, through October 31, 2011. Meta-analysis was performed using a random effect model to estimate the overall effects of the smoking-free legislations. Meta-regression was used to investigate possible causes of heterogeneity in risk estimates.ResultsA total of 18 eligible studies with 44 estimates of effect size were used in this study. Meta-analysis produced a pooled estimate of the relative risk of 0.87 (95% confidence interval (CI): 0.84 to 0.91). There was significant heterogeneity in the risk estimates (overall I2 = 96.03%, p<0.001). In meta-regression analysis, studies with greater smoking prevalence decrease produced larger relative risk (adjusted coefficient −0.027, 95% CI: -0.049 to −0.006, p=0.014).ConclusionSmoke-free legislations in public and work places were associated with significant reduction in acute MI risk, which might be partly attributable to reduced smoking prevalence.
Highlights
Comprehensive smoke-free legislation has been implemented in many countries
All of the studies were based on acute myocardial infarction (MI) hospitalization except that three studies used acute MI mortality data [17,25,26]
When we re-ran the analysis inputting a 19% reduction rather than 8%, the pooled estimate remained as 87%
Summary
The current study quantitatively examined the reduction in risk of acute myocardial infarction (MI) occurrence following the legislations and the relationship with the corresponding smoking prevalence decrease. According to the US Surgeon General’s report, tobacco smoking is a major population risk factor for coronary heart disease, the leading cause of deaths in the US [4]. Including acute myocardial infarction (MI), coronary heart disease has remained the second leading cause of deaths over the past three decades [4,5]. The harmful health effects of smoking has prompted investigate the relationship between reduction in smoking prevalence and the acute MI rate change after the smoking-free legislations
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