Italy's 2005 smoking ban has led to a sharp fall in heart attacks, researchers reported on Monday in a finding they said shows that such laws really do improve public health.
Following the ban the number of heart attacks in men and women aged 35-64 -- people most likely to be exposed to smoke in cafes, bars and restaurants -- fell 11 per cent, the researchers said.
The findings showed the health benefits of European smoking bans in public places, said Francesco Forastiere, an epidemiologist at the Rome Health Authority who led the study.
"Most of this change is due to the decreased impact of passive smoke," he said in a telephone interview. "This is ... important because it shows the impact of a health intervention that can be achieved in other countries."
Italy, Britain, Ireland and a number of other European countries have outlawed smoking in public places, and many health experts are urging the European Union to adopt an even wider ban.
The ban in Italy, where the researchers said about 30 per cent of men and 20 per cent of women smoke, prohibited smoking cigarettes in all indoor public places such as offices, retail shops, restaurants, pubs and discos.
"Smoking bans should be extended to all possible countries and smoking bans in the workplace should be strongly enforced," the researchers wrote.
Writing in the American Heart Association journal Circulation, the researchers compared the rate of heart attacks from 2000 to 2004 to those occurring in the year after the ban was enforced.
The team analysed hospital records and adjusted for heat waves, flu epidemics, air pollution and other factors that could have contributed to heart attacks. The researchers also took daily measurements on air quality in 40 public places.
"The smoking ban in Italy is working and having a real protective effect on population health," Forastiere said.
After the ban, cigarette sales also fell 5.5 percent but the researchers attributed the health benefits seen in the study to reduced exposure to passive smoke.
They said young men and women living in poorer areas appeared to have the greatest health benefit after the ban.
Smoking kills about four million people each year while about a quarter of deaths related to heart disease are due to cigarettes, according to the World Health Organisation.