Smoke-free air = fewer heart attacks

Awesome story in the WSJ this morning.

The Case for Bans on Smoking, WSJ.com

The growing numbers of bans on smoking in restaurants, bars and workplaces, intended to protect nonsmokers against second-hand-tobacco smoke, are turning into potent weapons in the battle to prevent heart attacks.

In one of the largest analyses to date of the dangers of passive smoking, researchers found that smoke-free laws reduced the rate of heart attacks by an average of 17% after one year in communities where the bans had been adopted. The benefit increased with time: After three years, the rate had dropped about 26%. The biggest declines in heart attacks were seen among non-smokers and people between the ages of 40 and 60 years.

A 17% to 26% reduction of risk “is a big deal,” says Steven Schroeder, a physician at University of California, San Francisco, and a proponent of smoking bans who wasn’t involved in the studies. “We can make immediate public-health progress if we cut exposure to second-hand smoke,” he says.

The findings were detailed in two reports, both of which were based on pooled analyses of separate studies from the U.S., Canada and Europe. The studies, conducted since 2004, involved a combined total of roughly 24 million people. David Meyers, a preventive cardiologist at the University of Kansas School of Medicine, and lead author of one of the reports, said that on a national basis, a 17% decline would amount to avoiding more than 150,000 heart attacks annually. Estimates published by University of San Francisco researchers in January put the annual cost of treating illnesses related to second-hand smoke in the U.S. at as much as $6 billion. Dr. Meyers’s report is scheduled to be published Sept. 29 in the Journal of the American College of Cardiology,

Researchers involved in the reports cautioned that pooled analyses have statistical flaws of their own that result in part from combining data from studies with different designs and goals. In general, researchers advise caution in using pooled analyses for hard conclusions.

There aren’t any initiatives in Washington aimed at adopting a national smoke-free law. But efforts continue in local communities to implement or broaden smoking bans. Kansas Gov. Mark Parkinson recently vowed to fight for an effective public-smoking ban next year after legislators had failed to approve such a law. Other areas that already have bans on smoking in enclosed public places are trying to expand these. New York City, which prohibits smokers from lighting up in offices, restaurants and bars, announced this month that it hopes also to stop smoking in municipal parks. And Richmond, Calif., which in May banned smoking in parks and at public events, more recently expanded the prohibition to include apartment buildings and condominiums to prevent second-hand smoke from drifting into units of non-smokers.

Laws against smoking in public places remain controversial. Restaurant, bar and casino owners worry that such bans could put them out of business by driving customers to nearby cities or states that lack such policies. The tobacco industry, which for years had disparaged as “junk science” evidence that second-hand smoke was harmful, is now taking a different approach.

“Our current position is to let the market take care of the issue,” says John Singleton, a spokesman for Reynolds American, the parent of R.J. Reynolds Tobacco. In venues such as bars, taverns and casinos that serve only adult customers, he says, “it should be up to the owners and operators to determine whether they should be able to accommodate smokers without the government coming in and imposing a one-size-fits-all kind of law.” And patrons of such establishments should be able to decide for themselves whether they want to risk exposure to second-hand smoke, he adds.

Currently, 17 states, Washington, D.C., Puerto Rico and more than 350 cities and towns in the U.S. have regulations banning smoking in workplaces, bars and restaurants, according to advocacy group Americans for Non-smokers Rights. The bans cover about 40% of the U.S. population, says Cynthia Hallett, the group’s executive director. An additional 14 states prohibit smoking in one or two of those public locations. And 19 states—mostly in the South and the Midwest—don’t completely outlaw smoking in any public area, the group says.

The new scientific reports analyze studies from nearly a dozen locales—ranging from Helena, Mont., and New York State to Scotland, which banned smoking in all public places in 2006. Results from different locations varied: In Rome, for instance, there was essentially no impact on heart-attack rates one year after a ban took effect. Researchers suggested this might be due to the short time frame of the study.

By comparison, Pueblo, Colo., had a net 36% reduction in heart attacks three years after smoking was prohibited in bars, restaurants, bowling alleys and other establishments.

Generally, the studies compared the rates of hospital admissions for heart attack or unstable chest pain before and after a ban was implemented, and compared these against such rates in nearby communities where such a law wasn’t in place. In some cases, patients were asked whether they smoked or not, and non-smokers’ exposure to second-hand smoke was confirmed with blood tests.

James Lightwood and Stanton Glantz, tobacco researchers at University of California, San Francisco, conducted a separate analysis using most of the same pooled data, but with some differences in methodology. These researchers found the same 17% average reduction in the rate of heart attacks one year after smoking bans went into effect. But after three years, this analysis found an average reduction of 36%. The team’s findings are published in the Oct. 6 issue of Circulation, a journal of the American Heart Association.

While smoking tobacco is known to heighten risk of heart attacks over a lifetime, there is some evidence that even short exposure to second-hand smoke can raise the risk of heart attacks. It can increase blood pressure, cause blood platelets to become sticky and injure cells that line the interior walls of blood vessels—all factors that can promote heart attacks.

One physician who has seen first-hand the effects of second-hand smoke on heart attack rates is Richard P. Sargent, a family doctor in Helena. He and some colleagues noticed a sharp drop in heart-attack admissions at the city’s main hospital about three months after a ban against smoking in bars, restaurants and casinos went into effect in June 2002. Then in December of that year, opponents succeeded in getting the ban revoked.

“We performed an ideal experiment,” Dr. Sargent recalls. “We turned [the ban] on, and we watched the heart-attack rate go down. We turned it off and watched it go back up.” The reduction was 40% in absolute terms—102 heart attacks per 100,000 person years after the ban, compared to 170 before the ban. Heart-attack rates rose sharply again after the ban was revoked, he says.

Dr. Sargent published the results in 2004, and this helped convince other communities to impose smoking bans and inspired further research into their effects in the U.S. and Europe. But opposition delayed a reinstatement of the ban in Helena. In 2005, a state law went into effect leading to prohibition of smoking in restaurants. And next month smoking will once again be forbidden in Helena’s bars under a Montana law that will affect such establishments across the state.