Bans on smoking in public places and workplaces can sharply reduce the number of heart attacks among both smokers and nonsmokers, according to a new report issued today by the prestigious Institute of Medicine. The report provides strong support for the anti-smoking laws that are now in place in 21 states and the District of Columbia and is likely to bolster efforts to pass such laws elsewhere.
"It's clear that smoking bans work," said Dr. Lynn R. Goldman of the Johns Hopkins Bloomberg School of Public Health, who chaired the panel that produced the report. "Bans reduce the risk of heart attacks in nonsmokers as well as smokers."
"There's no question that secondhand smoke has an adverse health impact in workplaces and public environments," added Dr. Clyde Yancy, president of the American Heart Assn. "We must continue to enact comprehensive smoke-free laws across the country to save lives and reduce the number of new smokers."
Nearly 440,000 Americans die each year from smoking-related illnesses, more than a third of them heart disease, according to the heart association. About 38,000 of those deaths are related to secondhand smoke, which has many characteristics of other types of air pollution -- which has also been linked to heart disease. The association between illness and secondhand smoke was reinforced by the 2006 Surgeon General report on the consequences of exposure to environmental smoke.
But bans on smoking have remained controversial, in part because of fears that they would reduce traffic in bars and restaurants. Last year, the Centers for Disease Control and Prevention commissioned the Institute of Medicine to study the evidence. Some of the members of the panel were initially skeptical about the benefits of such bans, according to statistician Stephen E. Fienberg of Carnegie Mellon University in Pittsburgh, but they quickly changed their minds when they began reviewing the evidence.
The panel examined 11 studies of heart attacks in areas where bans were implemented and found a decrease in heart attacks in every study, ranging from a low of 6% to a high of 47%, depending on how the study was conducted. "Such consistent data confirms for the committee that smoking bans do, in fact, decrease the rate of heart attacks," they wrote. One study, for example, found that hospitalizations for heart attacks in Pueblo, Colo., dropped 41% in the three years after the city banned smoking in the workplace. In most of the studies, it was difficult to isolate the benefits for nonsmokers from those for smokers, but two of the studies showed a very clear benefit for nonsmokers.
The committee also surveyed the evidence from laboratory studies in animals and concluded that these results too supported bans. The studies show that particulates and other toxins in cigarette smoke can trigger heart attacks in people who have heart disease and may not know it, providing the final shove that pushes them into cardiac arrest.
-- Thomas H. Maugh II
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