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STEMI incidence falls in Southern Switzerland after smoking ban implemented 

Topics: Cardiovascular Disease Prevention - Risk Assessment and Management
Date: 31 Aug 2013
STEMI incidence fell in Southern Switzerland after implementation of the smoking ban in public places.

Amsterdam, The Netherlands – Saturday 31 August 2013: STEMI incidence fell in Southern Switzerland after implementation of the smoking ban in public places, reveals research presented at the ESC Congress today by Dr Alessandra Pia Porretta from Switzerland.

Second-hand smoke increases the risk of coronary artery disease and acute myocardial infarction. For this reason, health policies aimed at reducing tobacco consumption and public smoke exposure are strongly recommended.

Dr Porretta said: “Canton Ticino (CT), which is one of the 26 cantons of the Swiss Federation, was the first Swiss canton to introduce a smoking ban in April 2007. We had the opportunity to assess the long-term impact of the smoking ban on the incidence of ST-segment elevation myocardial infarction (STEMI) and to compare STEMI epidemiology with Canton Basel City (CBC), where the law was not yet implemented.”

The principal investigator of the study (Dr Marcello Di Valentino) collected data retrospectively from the codified hospital discharge registry (ICD-10 codes) on STEMI hospitalisations in CT and CBC during the 3 years before (2004-2007) and after (2007-2010) the ban was implemented in CT.  

In CT, data were acquired from the four cantonal public hospitals and from Cardiocentro Ticino, an exclusive institution for invasive coronary interventions. In CBC, data were obtained from the public University Hospital of Basel. For each considered year, STEMI incidence per 100,000 inhabitants was calculated for both CT and CBC using demographic data from the Swiss Federal Statistical Office.

The study found a significant and long-lasting reduction in the incidence of STEMI hospitalisations in the overall population of Canton Ticino after the smoking ban was implemented. Incidence reduced by an average of 21.1% between 2004-07 and 2007-2010. Compared to 2004-2007, incidence reduced by 23% in 2007-2008, 15% in 2008-2009, and 24% in 2009-2010 (see figure 1A).

When population subsets were analysed, the researchers found that the significant and long-lasting reduction in STEMI admissions was observed only among older people, with a 27.4% post-ban decrease in women ≥65 years and a 27.3% reduction in men ≥65 years. Younger people (<65 years) of both sexes showed a reduction (statistically significant in men, near to significance in women) in STEMI admissions only in the first year after the ban was enforced, with no significant decrease in the second and third years (see figure 1B).

Dr Porretta said: “The varying impact of smoke-free legislation between age groups may be explained in part by the different role played by passive and active smoking in younger and older people.”

In CBC there was no change in the overall population incidence of STEMI between 2004-2007 and 2007-2010. When age and sex-standardised values were analysed, the researchers found a significant decrease in STEMI admissions in men ≥65 years old in each of the 3 years after CT’s smoking ban was implemented.

Dr Porretta said: “This could be due to ban-independent changes in the smoking habits of male smokers. Previous studies have shown that men ≥65 years make up the highest proportion of former smokers. Targeted treatment and prevention efforts towards this high risk STEMI group may also have had an impact.”

She concluded: “Introduction of the smoking ban in public places induced a significant and long-lasting reduction in the incidence of STEMI among the overall population of Canton Ticino in Switzerland. The greatest impact was seen in women ≥65 years old.”



Authors: ESC Press Office
For background information, please contact the ESC Press Office.
For independent comment on site, please contact the ESC Spokesperson coordinator.

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is "The Heart Interacting with Systemic Organs".  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on ESC Congress 2013 contact the ESC Press Office.

References

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2013. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.

More information on the ESC Press Conference page: Smoking, yet more burning issues