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The effects of smoke-free legislation on acute myocardial infarction: a systematic review and meta-analysis

Hualiang Lin12, Hongchun Wang3, Wei Wu12, Lingling Lang12, Qinzhou Wang4 and Linwei Tian56*

Author affiliations

1 Guangdong Provincial Institute of Public Health, Guangzhou, China

2 Center for Disease Control and Prevention of Guangdong Province, Guangzhou, Guangdong, China

3 Qilu Hospital of Shandong University, Jinan, China

4 Department of neurology, Qilu Hospital of Shandong University, Jinan, China

5 The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

6 Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China

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Citation and License

BMC Public Health 2013, 13:529  doi:10.1186/1471-2458-13-529

Published: 31 May 2013



Comprehensive smoke-free legislation has been implemented in many countries. The current study quantitatively examined the reduction in risk of acute myocardial infarction (MI) occurrence following the legislations and the relationship with the corresponding smoking prevalence decrease.


PubMed, EMBASE, and Google Scholar databases and bibliographies of relevant studies and reviews were searched for potential original studies published from January 1, 2004, through October 31, 2011. Meta-analysis was performed using a random effect model to estimate the overall effects of the smoking-free legislations. Meta-regression was used to investigate possible causes of heterogeneity in risk estimates.


A total of 18 eligible studies with 44 estimates of effect size were used in this study. Meta-analysis produced a pooled estimate of the relative risk of 0.87 (95% confidence interval (CI): 0.84 to 0.91). There was significant heterogeneity in the risk estimates (overall I2 = 96.03%, p<0.001). In meta-regression analysis, studies with greater smoking prevalence decrease produced larger relative risk (adjusted coefficient −0.027, 95% CI: -0.049 to −0.006, p=0.014).


Smoke-free legislations in public and work places were associated with significant reduction in acute MI risk, which might be partly attributable to reduced smoking prevalence.

Smoke-free legislation; Acute myocardial infarction; Systematic review; Meta-analysis; Random effect