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Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood 

In one of the most important public health research studies published in 2008, the Centers for Disease Control published an update of the Pueblo Heart Study on December 30th. This epidemiological study was performed, prospectively, over a 3-year period between 2002 and 2004 in Pueblo, Colorado. During the second half of this study, Pueblo enacted stringent legislation to eliminate smoking in public places. The incidence of admissions to hospitals for heart attack in the Pueblo area were monitored throughout the course of this study, both before and after the smoking ban was initiated. . . .

There are a couple of factors that make this public health study so powerful, including its prospective design, and the fact that the entire population of the Pueblo area was assessed for changes in the incidence of heart attack following the implementation of a new ban on smoking in public places. Also, the heart attack admission rates for two adjacent communities without public smoking bans, including the much larger Colorado Springs area, added an important set of controls that have not been included in similar previous studies. . . .

The updated data from this study reveals a striking cumulative reduction in the number of hospital admissions for heart attacks. When compared to the number of heart attack admissions that occurred prior to the enactment of the public smoking ban, there was an incredible 41 percent reduction in such admissions noted during the additional 18 months of follow-up data. Thus, within 3 years of implementing a public smoking ban, the number of heart attacks in Pueblo dropped, amazingly enough, by nearly one-half. At the same time, similar data collected from two surrounding communities without a public smoking ban showed no significant changes in heart attack admissions during the same timeframe.

I should note that, while this study did not separate smokers from nonsmokers, previous studies have shown that susceptible nonsmokers appear to be at an especially high risk of experiencing heart attacks due to exposure to secondhand smoke. . . .

Based upon more than five decades of scientific data linking tobacco smoke with cancer, chronic lung disease, and cardiovascular disease, it still amazes me that there are so many communities that still permit smoking in public places, or that have enacted hopelessly anemic limitations on the ability of smokers to subject the 80 percent of the U.S. population that does not smoke to highly toxic secondhand tobacco smoke. An estimated 500,000 people die every year in the United States, alone, from completely preventable tobacco-associated diseases. This updated data from the Pueblo Heart Study should galvanize public health advocates and agencies, and government leaders, to better protect the public from unwanted exposure to tobacco smoke.

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EDITOTRIAL: Another indictment of secondhand smoke  

Washington's indoor smoke ban - a law pioneered in Pierce County - is looking even smarter than anyone first thought.

When the ban was enacted by initiative in 2005, the case for it largely rested on the health of people who work in smoky places - bartenders, waiters and the like. They were at risk, the argument went, because they were forced to breathe the exhaust of smokers eight or more hours a day.

And so they were. But an accumulating body of evidence suggests that other nonsmokers are also placed at grave and immediate risk by shorter exposures to tobacco smoke. . . .

Some defenders of tobacco have countered that the researchers didn't distinguish between smokers and nonsmokers who'd suffered heart attacks. They suggest that the numbers might have been driven down by people quitting smoking after the ban.

The fact that people experience dramatically fewer heart attacks shortly after quitting smoking is not much of an argument against smoke bans - which help smokers quit. In this case, though, the Centers for Disease control cited an earlier study that did distinguish between smokers and nonsmokers. It found that nonsmokers got two-thirds of the risk reduction from a smoke ban, which translates into a large risk increase from secondhand exposure.

People who don't like smoke bans typically argue that adults ought to be able to make their own decisions about health and smoking. That's true. It's precisely why smokers should never be able to force their bad decisions on others through secondhand smoke.

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EDITORIAL: Our View: Secondhand smoke-health link inescapable  

A new study by the Centers for Disease Control and Prevention draws the strongest link ever between smoking bans and overall public health.

The study focused on the city of Pueblo, Colo., and heart attack rates in that city over three years following the 2002 adoption of a workplace smoking prohibition. . . .

The growing body of evidence that tobacco bans save lives simply cannot be ignored.

That was part of what drove Weston to adopt its ban last month. And it should be the argument that drives other central Wisconsin municipalities and the state to pass bans.

This isn't about property rights. It isn't about eating your fish fry without someone exhaling a cloud of smoke in your face.

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Smoking ban opponents mostly still opposed 

Lee Mauer read the recent news report about a possible link between a community's smoking ban and a drop in heart attacks there.

But Mauer says the new research won't change his view on local smoking bans.

"In this day and age, everyone knows smoking can kill you," the 24-year-old smoker said while flicking his cigarette in an ash tray at a Greater Lafayette bar. Still, Mauer said, he believes the choice of banning smoking should be decided by business owners and not by politicians.

Although proponents of the local smoking bans said the new research helps strengthen their case, the research had little impact on some opponents' views. . . .

Patti O'Callaghan is a former West Lafayette City Council member and author of the city's smoking regulations. O'Callaghan said the new research strengthens the argument for smoking bans.

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Study links smoking bans, heart attack rate  

New evidence suggests that heart attacks will be in sharp decline in Colorado in 2009 thanks to the statewide smoking ban enacted two and a half years ago.

A study out of Pueblo, endorsed by the national Centers for Disease Control and Prevention, found that hospitalizations for heart attacks continue to plunge there, five years after the city enacted its ban in 2003.

Like Pueblo, in 2003, Greeley banned smoking in restaurants, bars, businesses and other places where people gather.

Several cities, including Greeley, found that heart attacks went down in the 18 months after a smoking ban began.

The number of heart attacks in Greeley, for example, dropped by 16 percent in Greeley, according to the University of Colorado Health Sciences study.

But the new study released Thursday looked at the next 18 months — a total of three years of data — in Pueblo

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Heart Attack Hospitalizations Drop After US City Bans Smoking, CDC 

In the US city of Pueblo in the state of Colorado there has been a sharp drop in the number of hospital admissions for heart attacks following the introduction of a law that made it illegal to smoke in public spaces and workplaces. And the drop was steady for three years, said the US Center for Disease Control and Prevention (CDC).

The CDC study, which is reported in this week's Morbidity and Mortality Weekly Report (MMWR), found there were 399 hospital admissions for heart attack in Pueblo over the 18 months preceding the introduction of the smoke-free ordinance on 1 July 2003. This figure fell by 27 per cent in the 18 months following the ban and then another 19 per cent in the next 18 months (the most recent period for which figures exist).

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EDITORIAL: Clear Air: Study reinforces the value of public smoking bans 

Whether or not the Pueblo results are borne out in other communities, the fact remains that workplace smoking bans do have a positive health impact -- both for the non-smokers who no longer have to face clouds of second-hand smoke and for the smokers who usually find themselves smoking less.

The best impact might be on the smokers who use the inconvenience of such bans as a springboard to quitting the habit altogether.

Last year, one of the few holdout restaurants that skirted Longview's 5-year-old workplace smoking ban by barring any customers younger than 18, decided to join the mainstream and clear the smokescreen. Manager Fran Triplett told the Longview News-Journal that business at the Waffle Shoppes of Texas (on Marshall Avenue at Spur 63) was booming after it remodeled and went smoke free last summer.

When Longview first debated a proposal to institute its workplace smoking ban, there was some vocal, often rancorous criticism of the city council's decision to make our city one of the pioneers in clearing the public air. Since then, however, much of the nation has followed suit and the majority of Americans are breathing healthier, less odorous air because of it.

We're sure that the East Texans who carry out their resolutions to quit smoking this year will be glad to join that crowd.

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Study Says No Smoking Laws Reduce Heart Attacks 

U.S. health experts say laws that bar smoking in public places appear to dramatically cut the number of heart attacks according to a recent study conducted by the Centers for Disease Control and Prevention.

Researchers studying a smoking ban in the western U.S. state of Colorado say a no smoking law in one city led to a 40 percent decrease in the number of residents hospitalized for heart attacks.

Dr. Terry Pechacek, with the Centers for Disease Control and Prevention's Office on Smoking and Health, says the study indicates that secondhand smoke may be an under-recognized cause of heart attack deaths.

"For too long we have considered exposure to secondhand smoke in restaurants, bars, and other places as typical and common, however, these data indicate that even brief exposure to secondhand smoke can produce rapid and adverse changes in the functioning of the heart and blood, and cause heart attacks," he said.

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Health Highlights: Dec. 31, 2008  

Firm Says FDA OKs Its Generic Version of Nicotine Gum

Watson Pharmaceuticals Inc. said Wednesday that the U.S. Food and Drug Administration had approved its generic version of the nicotine gum Nicorette, and it will begin selling the mint-flavored gum in early January.

The FDA approved the firm's over-the-counter nicotine polacrilex gum in 2 milligram and 4 milligram strengths. Nicorette, made by British drug maker GlaxoSmithKline PLC, is sold by Johnson & Johnson Healthcare. The agency approved Nicorette gum, available in six flavors, in February 1996, the Associated Press reported.

Watson said the market for over-the-counter nicotine gum was more than $300 million in the year ended September 2008. Perrigo Co. also makes a generic version of fruit-flavored Nicorette, AP said.

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VIDEO: Smoking Bans Prove Beneficial  

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Heart attacks expected to decline due to Colorado law on smoking 

New evidence suggests that heart attacks will be in sharp decline in Colorado in 2009 thanks to the statewide smoking ban enacted two and a half years ago.

A study out of Pueblo, endorsed by the national Centers for Disease Control and Prevention, found that hospitalizations for heart attacks continue to plunge there, five years after the city enacted its ban in 2003.

Several cities, including Pueblo, found that heart attacks went down in the 18 months after a smoking ban began. But the new study looked at the next 18 months - a total of three years of data - and found that:

* Hospitalizations for heart attacks fell another 19 percent from early 2004 to mid-2005, after dropping 27 percent in the first 18 months of the ban.

* Hospitalizations in Pueblo County - not including the city - and in neighboring El Paso County were tallied as a way of comparison. Those two counties, which did not have smoking bans at the time, did not show significant changes.

There is reason to believe - based on past studies - that the major benefactors are nonsmokers, those who breathed in secondhand smoke, say study author . . .

In an editorial in the CDC's Morbidity and Mortality Weekly Report, officials noted that following adoption of smoke-free laws, families tend to implement their own no-smoking rules, which further boosts overall health.

The editorial writers cautioned that there are limitations to the Pueblo study, including that it didn't differentiate between smokers and nonsmokers when gathering data.

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• Reduced Hospitalizations for Acute Myocardial Infarction After Implementation of a Smoke-Free Ordinance --- City of Pueblo, Colorado, 2002--2006 

The Pueblo Heart Study examined the impact of a municipal smoke-free ordinance in the city of Pueblo, Colorado, that took effect on July 1, 2003 (3). The rate of AMI hospitalizations for city residents decreased 27%, from 257 per 100,000 person-years during the 18 months before the ordinance's implementation to 187 during the 18 months after it (the Phase I post-implementation period).* This report extends that analysis for an additional 18 months through June 30, 2006 (the Phase II post-implementation period). The rate of AMI hospitalizations among city residents continued to decrease to 152 per 100,000 person-years, a decline of 19% and 41% from the Phase I post-implementation and pre-implementation period, respectively. No significant changes were observed in two comparison areas. These findings suggest that smoke-free policies can result in reductions in AMI hospitalizations that are sustained over a 3-year period and that these policies are important in preventing morbidity and mortality associated with heart disease. This effect likely is mediated through reduced SHS exposure among nonsmokers and reduced smoking, with the former making the larger contribution (4,6,7). . . .

Editorial Note:

Evidence from animal and human studies indicates that SHS exposure can produce rapid adverse effects on the functioning of the heart, blood, and vascular systems that increase the risk for a cardiac event (1). Relevant mechanisms include effects on platelet function, endothelial function, and inflammation. Epidemiologic and laboratory data indicate that the risk for heart disease and AMI increase rapidly with relatively small doses of tobacco smoke, such as those received from SHS, and then continue to increase more slowly with larger doses (1,8,9). Evidence also suggests that the acute effects of SHS exposure might be rapidly reversible (8,9).

Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from SHS

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• Pueblo smoking ban leads to drop in heart attacks, study finds 

Heart attacks fell sharply in Pueblo in the years after a city smoking ban took effect, according to a report released Wednesday, and researchers say it's the strongest link yet between such laws and improved health.

The southern Colorado city saw a 41 percent drop in heart attack hospitalization rates among city residents in the three years after a smoking ban took effect July 1, 2003, according to the report by the U.S. Centers for Disease Control and Prevention. The size of the drop surprised researchers, said the study's lead researcher, Terry Pechacek, associate director for science at the CDC's Office on Smoking and Health.

"The significant continued decline was not predicted," he said. Several studies have shown that heart attacks decrease significantly when smoke-free laws are in place, but this was the first to show that such declines seem to continue over time.

Pechacek said it suggests that the risk of secondhand smoke might be underestimated, and that Colorado's smoking ban, which took effect July 1, 2006, can only go so far in protecting people.

"Even with the statewide law, people need to recognize that they need to pay attention to secondhand smoke in homes, vehicles and everywhere else," he said. . . .

"This study is very dramatic," said Dr. Michael Thun, a researcher with the American Cancer Society who was not involved in the CDC study. "This is now the ninth study, so it is clear that smoke-free laws are one of the most effective and cost-effective to reduce heart attacks." . . .

"I have never seen any proof at all that secondhand smoke is hazardous to anybody's health," said Bruce Hicks, owner of Murray Street Darts, who has been fighting the ban in court after being cited for openly defying it. "And besides that, I still think it's a business rights issue rather than a health issue."

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• Heart Attack Deaths Drop in U.S. as Smoking, Diet, Drugs Help  

Heart attacks and stroke deaths dropped by a third in 2006 from 1999 as more people stopped smoking, ate better and used medications such as Bristol-Myers Squibb Co.’s Plavix to keep blood flowing freely within arteries.

Heart disease accounted for 1 in 3 U.S. deaths in 2006, the latest year for which data is available, the Dallas-based American Heart Association said in a statement today. Drugs including cholesterol-lowering statins such as Pfizer Inc.’s Lipitor and the Plavix blood-thinner joined with better heart- attack treatment to lower the mortality rate, the health advocacy group said.

The heart association, which includes doctors and consumers in its membership, has lobbied against smoking for years. In 1998, the group set a national goal of reducing heart and stroke deaths 25 percent by 2010. The U.S. hit that mark in 2007, three years early. The change in death rates translates to about 190,000 lives saved in 2006.

“Medical therapy across the board has gotten better,” said Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio. “But at least half of this is lifestyle. Remember that there have been new food labeling laws, laws to restrict trans fats, and smoking has been steadily declining for some time.”

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[A]t least half of this is lifestyle. Remember that there have been new food labeling laws, laws to restrict trans fats, and smoking has been steadily declining for some time.
Steven Nissen, head of cardiology at the Cleveland Clinic, on news that heart attacks and stroke deaths dropped by a third between 1999 and 2006.

Rates Coming Down for Heart Disease, Stroke Deaths 

Death rates from stroke and coronary heart disease have dropped dramatically in the past decade, but despite repeated warnings to the public, risk factors for the dangerous conditions are still too high, the American Heart Association says.

In the AHA's latest report, researchers say age-adjusted death rates from coronary heart disease have declined 30.7% since 1999, and that mortality from stroke has dropped 29.2%.

"The 30% reduction is incredibly good news," Don Lloyd-Jones, MD, ScM, lead author of the update, tells WebMD. "But we don't see that as likely to continue."

He says the reductions "mark the achievement of major milestones set by the American Heart Association to reduce coronary heart disease and stroke [death] by 25% by 2010."

However, he says "there's a lot of worry that we are about to reverse" the positive trends. Risk factors for the conditions remain too high, according to the report, "Heart Disease and Stroke Statistics - 2009 Update," published in Circulation: Journal of the American Heart Association.

"The American Heart Association is proud of the progress this country has made against America's No. 1 single cause of death and the No. 3 killer," says Timothy Gardner, MD, president of the AHA. "But our work is not done, since the major risk factors for heart disease and stroke have not seen the same decline as the death rates, and several are rising."

If the trend continues, he says, "death rates could begin to rise again in the years ahead." Although patients are working harder to control high blood pressure and high cholesterol and to quit smoking, "progress continues to lag in obesity, diabetes and physical inactivity."

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