Dramatic Drop in Heart Attacks Attributed to Smoking Ban

The adverse effects of smoking on human health are serious and in many cases, deadly. In the United States, cigarette smoking accounts for nearly 440,000 deaths annually; more than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. However, for every eight smokers who die from smoking, one innocent bystander dies from secondhand smoke, also known as passive or environmental tobacco smoke (ETS), which is a combination of smoke exhaled by smokers and the smoke given off by the burning end of a cigarette, cigar, or pipe. Medical research has shown that nonsmokers who breathe secondhand smoke suffer many of the same diseases as smokers, including lung cancer and heart disease. According to CDC statistics, secondhand smoke causes an estimated 3,000 lung cancer deaths and 46,000 heart disease deaths among nonsmokers each year.

Passive smoking, or breathing in secondhand smoke, is the main reason why smoking bans are recommended and enforced in indoor public places such as restaurants, bars, nightclubs and workplaces. Numerous studies have linked smoking bans to a decrease in heart attacks, the latest being that of a smoking ban in Pueblo, Colorado, which resulted in a 41 percent reduction in heart attack hospitalizations in the three years following a city-wide ban of workplace smoking.

In the new study, the longest running of its kind, researchers reviewed hospital admissions for heart attacks in Pueblo and for two nearby areas that did not have bans—the area of Pueblo County outside the city and El Paso County—for three years following the July 1, 2003 enactment of Pueblo’s ban. In Pueblo, the rate of heart attacks dropped from 257 per 100,000 people before the ban to 152 per 100,000 in the three years afterward. There were no significant changes in the other two areas, which researchers believe is a clear sign that the ban was responsible. “The need for protection from secondhand smoke in all workplaces and public places has never been clearer,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a prepared statement.

However, Dr. Michael Siegel, a professor of social and behavioral sciences at the Boston University of Public Health, is not convinced that there’s enough evidence to conclude the smoking ban was the cause of Pueblo’s heart attack decline. He suggests that the decline could have had more to do with a general decline in smoking in Pueblo County, from about 26 percent in 2002-2003 to less than 21 percent in 2004-2005. If there were stepped-up efforts to treat or prevent heart disease in the Pueblo area, that too could have played a role, Siegel said. “I don’t think it’s as clear as they’re making it out to be.”

One of the study authors, Terry Pechacek of the U.S. Centers for Disease Control and Prevention, said the study suggests that secondhand smoke may be a terrible and under-recognized cause of heart attack deaths in this country. According to experts, just 30 minutes of exposure to secondhand smoke significantly increases the person’s risk for heart attack. This is because tobacco smoke contains carbon monoxide (found in car exhaust), a known blood vessel constrictor, which may cause the amount of oxygen carried out in the blood to decrease significantly. However, carbon monoxide isn’t the only poisonous gas or chemical in secondhand smoke. The National Toxicology Program estimates that at least 250 chemicals in secondhand smoke are known to be toxic or cancer causing, including hydrogen cyanide (used in chemical weapons), butane (used in lighter fluid), arsenic (used in pesticides), and cadmium (used to make batteries).

In the 2006 report, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, the Surgeon General has concluded that eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke, while separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.