Smoking bans drive down heart attack rates

Still nipping out of your workplace or a restaurant to cop a cigarette out on the sidewalk? You are public health hero, and a grateful nation salutes you.

Workplaces and eating and drinking establishments that are free of second-hand smoke have shored up Americans’ health even in the face of rising levels of obesity and Type 2 diabetes, says a new study. Published Monday in the Annals of Internal Medicine, the latest research focused on Olmsted County in Minnesota, and tracked the rate of heart attacks and sudden heart attack deaths in the wake of smoking bans that cleared Olmsted County’s restaurants, bars and workplaces of tobacco smoke.

Banning indoor tobacco use from restaurants and workplaces drove down the rate of heart attacks by one-third in Olmsted County and reduced sudden cardiac death rates there by 17%. Interestingly, the study found that outlawing tobacco smoke in restaurants alone was not enough to have any discernible effect: It was not until phase 2 of the Olmsted County ordnance was implemented--forbidding cigarette smoking inside of bars and workplaces as well--that the full influence of the measure became clear.

A boost in tobacco taxes and smoking-cessation campaigns caused many Minnesotans to quit smoking during the study period--2002 to 2007-- the authors noted. But those trends did not fully explain the drop in heart attacks and sudden cardiac deaths, they wrote: Removing the exacerbating effect of second-hand-smoke appears to have accelerated a trend already in the making.

Those smoking outside may be reluctant public health heroes, but an accompanying editorial in the Annals of Internal Medicine makes clear that people who still smoke do not smoke more at home to compensate for the restriction that bar their smoking inside workplaces, bars and restaurants. In fact, the widespread establishment of no-smoking zones in homes seems to have followed the restaurant and workplace bans, with the overall effect that those who continue to smoke appear to smoke less than they once did.

Second-hand smoke is, alas, not a wholly disappearing ill: Cigarette smoking remains widely allowed in multi-unit housing where shared ventilation systems can carry tobacco smoke and its irritants from apartment to apartment; smoking in cars, in casinos and in outdoor places continue to expose those with respiratory and heart ailments to second-hand smoke.

“We should prioritize the enforcement of smoke-free policies, eliminating loopholes in existing policies as well as encouraging the expansion of smoke-free policies” to include apartment buildings, cars, casinos and outdoor locations, write UC San Francisco physicians Sara Kalkhoran and Pamela M. Ling. Such places may house and employ many lower-income people, whose health should not be compromised by loopholes, they write.