Smoking Bans Reduce Heart Attacks and Disease

Smoking Bans Reduce Heart Attacks and Disease

Bans on smoking in places like restaurants, offices and public buildings reduce cases of heart attacks and heart disease, according to a report released Thursday by a federally commissioned panel of scientists.
The report, issued by the Institute of Medicine, concluded that exposure to secondhand smoke significantly increased the risk of a heart attack among both smokers and nonsmokers. The panel also said it found that a reduction in heart problems began fairly quickly after a smoking ban was instituted and that exposure to low or fleeting levels of secondhand smoke could cause cardiovascular problems.
“Even a small amount of exposure to secondhand smoke can increase blood clotting, constrict blood vessels and can cause a heart attack,” said Dr. Neal L. Benowitz, a professor of medicine, psychiatry and biopharmaceutical sciences at the University of California, San Francisco, and a member of the panel.
“Smoking bans need to be put in place as quickly as possible,” Dr. Benowitz added. “The longer we wait, the more disease we are accepting.”
The report, commissioned by the Centers for Disease Control and Prevention, examined data from 11 studies from communities in Canada, Italy, Scotland and the United States.
The degree of heart attack reduction in those communities varied widely, from 6 percent to 47 percent, but every study showed a decline.
“The evidence is now overwhelming,” said Dr. Richard D. Hurt, director of the nicotine dependence center at the Mayo Clinic, who was not involved in the report.
“Secondhand smoke kills a lot of people,” Dr. Hurt said, “and one of the mechanisms by which it does is through exposure and the effect on the cardiovascular system.”
The committee said that none of the 11 studies were optimal in method or in data collection, making some significant questions unanswerable. Some studies were small, some were conducted over a short time, and only two, in Scotland and in Monroe County, Ind., noted whether heart attack victims were smokers or nonsmokers.
These limitations left the committee unable to determine why reduction rates varied so much. But some members speculated that places like New York State, which had some smoking restrictions in place before instituting more comprehensive bans, would already have been showing improvement, so reductions from bans would be smaller.
“Evidence was not strong enough to say the degree” to which smoking bans reduce risk or the degree to which “individual lifestyle, community and societal factors can also influence the magnitude” of heart disease reduction, said Dr. Lynn R. Goldman, the panel’s chairwoman, a professor of environmental health sciences at Johns Hopkins University.
Dr. Michael Siegel, professor of community health sciences at Boston University, said that such limitations were significant flaws and that the panel was being “sensationalistic” about the impact of smoking bans.
“Anybody could have told you without any kind of review that smoking bans don’t raise heart attacks,” Dr. Siegel said, but “it could be that they have an exceedingly small effect” and that reductions were “just occurring anyway” because of improvements in treatment of heart disease.
A panel member, Dr. Eric D. Peterson, a cardiologist at Duke, said that even if reduction rates were small, the studies supported bans.
Dr. Goldman said the committee found that “a cause-and-effect relationship exists between heart disease generally and secondhand smoke exposure.”
“It increased the risk of coronary heart disease by about 25 to 30 percent,” she added.
Dr. Siegel said that connection was “unequivocal,” but that a significant risk applied only in people who have severe heart disease. “An otherwise healthy person is not going to walk into a bar for 20 minutes and have a heart attack,” he said.
Seventeen states, Puerto Rico and the District of Columbia ban smoking in bars, restaurants and workplaces, while 14 other states ban smoking in one or two of those types of establishments, according to Americans for Nonsmokers’ Rights, an advocacy group. More than 350 cities and towns have similar bans.
The panel’s report echoes two recent studies which found that one year after smoking bans were put in place, the average rate of heart attacks had dropped by 17 percent, and continued to drop more over time.
David Sutton, a spokesman for Philip Morris U.S.A., said that he could not comment on the institute report until the company had had a chance to review it, but that the company supported smoking bans in public areas.
“Private business owners should have the flexibility” to “cater to smokers and nonsmokers alike,” Mr. Sutton said, but “there are sufficient reasons to warrant measures that regulate smoking in public places, places where people must go.”