Scotland sees decrease in acute coronary syndrome post-ban

The smoking ban in Scotland has led to a decrease in the number of hospital admissions for acute coronary syndrome (ACS), and the benefit of the smoking ban has extended to smokers, former smokers, and those who never smoked, a new study published in the New England Journal of Medicine has shown.

The Smoking, Health, and Social Care Act was passed in 2005, prohibiting smoking in all enclosed public spaces and workplaces in Scotland after March 2006. The purpose of this analysis, from the University of Glasgow, was to document the number of admissions for ACS before and after the ban. The study looked at nine hospitals that served a population of 3 million and captured 64% of all ACS events.

In the 10 months after the implementation of the legislation, there was a 14% reduction in number of admissions for ACS among smokers, a 19% reduction among former smokers, and a 21% reduction among those who never smoked. Among those who never smoked, there was a reduction in exposure to second-hand smoke; this self-reported finding was confirmed by reductions in their mean serum cotinine concentrations.

"The ban appears to be working in two ways," said lead author Dr. Jill P. Pell. "It is protecting nonsmokers, but it also appears to be getting existing smokers to quit or reduce smoking."

Pell added that the smoking ban is changing social norms; there is now less acceptance of smoking. "There needs to be more clinical support to help individuals to quit," she said. "In the 3 months leading up to the ban, calls to a national smoking hotline went up 67%. Obviously, there is a willingness to use the legislation as an impetus to give up smoking, and that should be supported."

More studies will be needed to determine whether these early improvements are sustained. Smokers who quit could relapse, but with the changing social attitudes toward smoking, there is hope that younger people will be discouraged from starting.

NEJM: Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome - Jill P. Pell, M.D