The Scottish Government recently announced that there was a dramatic 17% fall in admissions for MI at nine major Scottish hospitals in the year following the introduction of smokefree legislation.¹ This compares with an average annual reduction during the previous decade of just 3%.

Now research from New York provides further evidence of the impact that restrictions on smoking can have on rates of hospital admission for MI.

In the most comprehensive study to date, published in the American Journal of Public Health, researchers from the New York State Department of Health reviewed nearly 500,000 admissions for acute MI between 1995 and 2004 to generate a statistical model predicting admission rates.

After accounting for all other factors, they found that there were nearly 4,000 fewer admissions than expected in 2004, the year after New York implemented a state ban on smoking in public places. This amounted to an 8% fall in admissions above that predicted by the historical model.

The authors attribute the significant fall in admissions to the smoking ban and point out that few interventions can deliver such a rapid and substantial improvement in public health. Aside from the health benefits, the reduction in hospital admissions translated into a saving of $56 million in direct healthcare costs during 2004 alone.

There is a biological basis for the findings, since even low-level exposure to tobacco smoke has been show to have adverse effects on the cardiovascular system.

The clinical implications of the research are most relevant to patients with existing cardiac conditions. While everyone should avoid active or passive smoking, cardiac patients in particular should be advised to quit or, if they do not smoke, avoid exposure to second-hand smoke.

Juster HR, Loomis BR, Hinman TM et al. Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban. Am J Public Health 2007 doi: 10.2105/AJPH.2006.099994