National Indoor Smoking Ban Could Prevent Thousands of Heart Attacks

May 23, 2010— -- Extending bans on smoking in public places nationwide would snuff out more than $92 million in heart attack-related direct costs alone in a single year, researchers said.

Comprehensive legislation barring smoking in public and private offices, restaurants, and bars -- even those with ventilated smoking areas -- would result in 18,596 fewer acute heart attack hospitalizations in the year following implementation, according to an analysis by Dr. Mouaz Al-Mallah of Henry Ford Hospital in Detroit and colleagues.

Even further benefits might be seen in other disease states, they reported at the American Heart Association's Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke conference.

Smoking's link to heart attack risk is well-established, the researchers noted.

An Institute of Medicine report, endorsed by the American Heart Association as well, suggested clear health benefits from smoking bans in reducing heart disease.

A CDC report also supported a long-term benefit with a dramatic 41 percent drop in heart attack hospitalizations maintained over three years after a comprehensive smoking ban went into effect in one city.

But while indoor smoking bans are growing in popularity, only 37 states had smoking bans in restaurants and bars and other public areas as of 2007, according to Al-Mallah's group.

Getting all states on board would be expected to have a substantial public health impact, but it hadn't been quantified, they said.

The investigators contacted the department of health of every state without comprehensive smoking ban legislation to determine the total number of acute heart attack discharges and the lengths of stay and charges in dollars for these hospitalizations in 2007.

In that year, the 14 states that did not have comprehensive smoking bans in place reported a total of 169,043 acute heart attack hospitalizations.

The researchers extrapolated results from a previously published examination of existing studies that concluded smoking bans result in an 11 percent reduction in the risk of acute heart attack to come up with the 18,596 acute heart attack reduction expected in the year after a nationwide ban.

The IOM committee that issued the earlier report on indoor smoking bans said the link between heart disease and secondhand smoke exposure is certain to be causal, but cautioned about lack of adequate adjustment for lifestyle and other factors in studies that have gone into the studies from which the meta-analyses draw.

Other studies have cautioned that these pre- versus post-ban analyses cannot distinguish the heart-attack rate impact of smokers who quit from reductions in secondhand smoke exposure.