Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis

J Am Coll Cardiol. 2009 Sep 29;54(14):1249-55. doi: 10.1016/j.jacc.2009.07.022.


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.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Humans
  • Incidence
  • Myocardial Infarction / epidemiology*
  • Patient Admission / statistics & numerical data
  • Prevalence
  • Public Facilities*
  • Smoking / epidemiology
  • Smoking / legislation & jurisprudence*
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / legislation & jurisprudence*
  • Tobacco Smoke Pollution / prevention & control


  • Tobacco Smoke Pollution