Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis

Abstract

Background Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smoke-free laws. Objective We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. Methods We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post- vs. pre-legislation using inverse-variance weighted random-effects models. Results Thirty-one studies providing estimates for 47 locations were included. The legislations were implemented between 1991 and 2010. Following the enactment of smoke-free legislations, there was a 12 % reduction in hospitalizations for acute coronary events (pooled RR: 0.88, 95 % CI: 0.85–0.90). Reductions were 14 % in locations that implemented comprehensive legislations compared to an 8 % reduction in locations that only had partial restrictions. In locations with reductions in smoking prevalence post-legislation above the mean (2.1 % reduction) there was a 14 % reduction in events compared to 10 % in locations below the mean. The RRs for acute coronary events associated with enacting smoke-free legislation were 0.87 vs. 0.89 in locations with smoking prevalence pre-legislation above and below the mean (23.1 %), and 0.87 vs. 0.89 in studies from the Americas vs. other regions. Conclusion The implementation of smoke-free legislations was related to reductions in acute coronary event hospitalizations in most populations evaluated. Benefits are greater in locations with comprehensive legislations and with greater reduction in smoking prevalence post-legislation. These cardiovascular benefits reinforce the urgent need to enact and enforce smoke-free legislations that protect all citizens around the world from exposure to tobacco smoke in public places.

Influence of Time and Frequency of Passive Smoking Exposure on Mucociliary Clearance and the Autonomic Nervous System

“…Thus, the damage caused by smoking can be extended to passive smokers. [5][6][7][8][9] The effects of exposure to cigarette smoke on mucociliary clearance and autonomic nervous systems in passive smokers has been investigated; these systems are considered mechanisms of great importance for the proper functioning of the body. 4,10 The changes in these systems precipitated by active smoking are already established; however, the effects on passive smokers are not yet fully clear.…”

“…12 Given the above, it can be seen that there are still gaps in the knowledge relating to the damage caused by passive smoking on the mucociliary and autonomous systems, especially regarding the influence of the frequency and duration of exposure to cigarette smoke on these systems. 9,10,12 It should be emphasized that despite the intensification of public policies established to reduce the harmful effects of passive smoking, individuals exposed in the home environment continue to be biased and need to be alerted to the potential damage. [8][9][10] Therefore, the aim of this study was to investigate the effects of passive smoking on mucociliary clearance and the autonomic nervous system in adults and to investigate the influence of the frequency and duration of passive exposure on these systems.…”

Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

“…21 Other meta-analyses have produced similar estimates (relative risks ranging from 0.83-0.87). 17,34,44 However, individual studies in the United States, Canada, and Ireland have found BMI indicates body mass index; and CARDIA, Coronary Artery Disease Risk Development in Young Adults study. *Participant exposure to smoke-free policies was defined as living in a Census tract in a state, county, or locality that implemented a 100% ban on smoking in restaurants, bars, or workplaces (100% indicates smoking completely prohibited in that type of venue with no exceptions).…”

Childhood Environmental Tobacco Smoke Exposure

“…Policies on banning smoking in public places and workplaces have been widely implemented and have already been associated with decreases in CVD. 29 Progress continues to be made as bans on smoking in cars with children have been enacted in at least 4 US states, 10 Canadian provinces, Australia, South Africa, Cyprus, England, and Wales. 30 In 2009, the American Academy of Pediatrics called for children to have universal smoke-free home, car, school, work, and play environments, both inside and outside.…”