11% drop in AMI admissions

Less acute heart attacks in Italy five months after the introduction of a smoking ban in indoor public places.

Researchers at Turin University have found that hospital admissions for acute heart attack, in people under 60, fell by 11% in the Piedmont region of Italy in the five months following the introduction of a smoking ban in indoor public places, compared with admissions for the same period in the previous year. In addition, they concluded that almost all of this reduction was probably due to reductions in passive smoking.
Their results were published in an online edition of the European Heart Journal (Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. EHJ. doi:10.1093/eurheartj/ehl201). An accompanying editorial (Public smoking ban: Europe on the move. European Heart Journal. doi:10.1093/eurheartj/ehl266) said the research adds more evidence to studies supporting the effectiveness of smoking regulations. ‘The argument of the “victimless crime” clearly and finally has to leave the discussion based on accumulating data, including this new research,’ said editorial co-author Dr Peter Radke, consultant cardiologist at the Department of Cardiology and Angiology, Schleswig-Holstein University Hospital, Lübeck, Germany.  

The Italian Government banned smoking in all indoor public places on 10 January 2005. The researchers, led by researcher Dr Francesco Barone-Adesi, of the Cancer Epidemiology Unit at Turin University, analysed all hospital admissions with discharge diagnoses of acute myocardial infarction (AMI), and AMI deaths, between January 2001 and June 2005, for residents throughout the region of Piedmont (population 4.3 million). From February 2005 to June 2005, they found a significant drop in AMI admissions of both men and women under 60 (832 cases compared with 922 for the same months in the previous year). In addition, rates of AMI had been increasing between 2001-2004, leading them to conclude that the reduction seen in the first half of 2005 was not attributable to long-term trends. ‘In fact,’ said Dr Barone-Adese, as there was evidence that AMI was increasing over time, it’s possible that our estimate of an 11% decrease after the introduction of the ban is even an underestimate.’

Active and passive smoking contributed to the fall, he said, but only around 1% was likely to be due to active smoking – a conclusion reached after studying the effects of the ban on active smokers’ habits. The observed reduction in active smoking accounted for just a 0.7% decrease in admissions, and about a 10% decrease was due to the sharp reduction of exposure to passive smoking, he pointed out.  

The decrease in admissions was confined to under 60s. Dr Barone-Adesi said several studies had found that the relative risk and attributable risk of AMI for smoking decreases with age. Although the reason is still debated, possibly  other risk factors become more important with aging. Also, younger people usually spend more time in public places exposed to smoke, so a different effect was not unexpected.  

Smoking, he explained, acts on the aggregation of platelets in blood and is most likely to acutely increase the risk of AMI, which ‘… might explain the 11% decrease in the first five months after the ban began. It suggests that smoking regulations may have important short-term effects on health. The long-term effects on respiratory and cardiovascular diseases and cancer will have to be evaluated over the years to come.’  

Professor Heribert Schunkert, Director of the Department of Cardiology and Angiology, Schleswig-Holstein University Hospital, and co-author of the editorial, said that the researchers had produced further evidence from national registries and surveys – an 8.9% fall in cigarette sales, 7.6% reduction in cigarette consumption and a more than 90% reduction in nicotine vapour phase concentration in pubs and discos - suggesting that Italy’s smoking ban did reduce overall smoking.


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