France and Italy have reported drops in admissions of patients with acute coronary events to emergency wards and health authorities in both countries are crediting this “striking decrease” to the bans on smoking in place in both countries.

In mid-February, the Italian Environmental Health Authority published two-year results showing an 11.2% reduction in coronary events in Rome.

Meanwhile in France, the Institut National de Veille Sanitaire (the National Institute for Health Surveillance) said, “It is ... too soon for us to say anything about the effects of the ban. In a few more months we may have better numbers for drawing conclusions.”

The European Society of Cardiology (ESC; Sophia Antipolis, France) seized upon the two reports to issue a press release where it stressed “the positive impact of smoking bans in all European countries that have adopted laws banning tobacco use in public places.”

ESC is a staunch backer of smoking cessation across the continent and said the positive figures from Italy and France should encourage other European countries to enforce similar measures.

The European Union does not have a mandate to formally ban smoking across the continent, though Markos Kyprianou, the European Commissioner charged with health-related issues, regularly forces a debate in Brussels to turn Europe into a smoke-free zone.

The EU says that passive smoking kills 79,000 Europeans per year, estimated to be one in nine tobacco-related deaths.

To date reports of the benefits of smoking bans on public health remain isolated and a comprehensive study has yet to be conducted to measure the success of recent anti-smoking legislation in member nations.

Europe has a historical claim to anti-smoking, reaching back to 1590 when Pope Urban VII threatened to excommunicate anyone who “took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe, or sniffing it in powdered form through the nose.”

Four hundred years later in March 2004, Ireland introduced the world’s first nationwide ban on smoking. Last year Cork University Hospital in Ireland reported that the immediate fall of 10% in the rate of heart attacks noted the year following the ban had been sustained in subsequent years, but had not improved from that initial drop.

Norway quickly followed the Irish example, banning smoking in bars, clubs and restaurants in June 2004, and Malta joined the no-smoking club in October of that year.

The ban in Italy went into effect in January 2005 and Sweden enforced a ban in June 2005.

Spain banned smoking in all workplaces, as well as bars and restaurants larger than 1,000 square feet in January 2006. Scotland banned smoking in all enclosed public places in March, 2006.

England enacted a ban starting last summer in all enclosed public places, and the French law took effect in January of this year.

A survey in 25 EU countries last year found that 65% of the population favor a smoking ban in public places, with the strongest support coming from Sweden with 90% in favor, and the most resistance coming from Austria, where a minority of 43% supported the ban in general terms but with higher resistance for banning smoking in bars and cafes.

Belgium, a nation founded on a compromise, reflects a balanced approach with smoking forbidden in all workplaces and railway stations but permitted in restaurants and cafes.

Germany has no national policy but restricts smoking in railway stations, selected trains, and in schools in five Landers, or states.

Resistance to smoking bans increases the further east one travels in Europe.

The World Health Organization (Geneva, Switzerland) in May 2007 called for a global ban on smoking at work and in enclosed public places, arguing there is no safe level of exposure to secondhand tobacco smoke.

“There is a wealth of data linking smoking and cardiovascular disease (CVD),” insisted Daniel Thomas, MD, of the ESC and senior cardiologist in the Centre Hospitalier Pitié-Salpêtrière (Paris). “Although further studies are needed all over France, these statistics show the same tendency professionals have already observed in Italy, Ireland and Scotland when these countries introduced bans on tobacco.”

In October 2006, ESC published in its European Heart Journal results of a study by the University of Turin (Turin, Italy) of the immediate impact of the smoking ban in the five months following its enactment in 2005 on the 4 million people living in the northern Piedemonte region.

“We found a significant drop in admissions for acute myocardial infarction (AMI), among both men and women under the age of 60, with 832 cases compared to 922 for the same months in the previous year,” said Dr. Barone-Adesi of the university’s Cancer Epidemiology Unit.

In an editorial in that issue of the European Heart Journal, Professor Heribert Schunkert, director of the department of cardiology and angiology at University Hospital of Schleswig-Holstein in Germany, said, “The implications of the study for public measures of health are important.”

Schunkert said an 8.9% fall in cigarette sales, a 7.6% reduction in cigarette consumption and a more than 90% reduction in nicotine vapor phase concentration in pubs and discos suggest the smoking ban in Italy did reduce overall smoking, but that the report strains to link these statistics to the observed effect on AMI admissions.

For the moment, ESC is constrained to basing its support of a pan-European smoking ban on limited local studies.

Berlin Heart CEO resigns, citing differences

The chief executive of Berlin Heart (Berlin), Dr. Rolf Kaese, said he is resigning from the company, citing strategy differences with Syscore, which acquired the company in October 2006 (Medical Device Daily, Oct. 12, 2006).

Kaese led Berlin Heart through the friendly acquisition by the investment fund controlled by the Stroeher family.

Ulrich Stroeher, chairman of the advisory board, said that board member Dr. Johannes Mueller will provisionally serve as the company’s general manager, while he and another Advisory Board member, Dr. Mathias Herter, will provide support.

A market leader in Europe, Berlin Heart specializes in ventricular-assist devices, offering a line of products adapted to the full range of age and body size for acutely ill patients. In addition to the InCor, ExCor and ExCor Pediatric heart pumps, the company manufactures pumps, cannulas and external components for internal and external use to stabilize cardiac activity.