Indoor smoking ban tied to heart attack decline in older adults

Heart attack rates dropped among older adults in Scotland in the decade after a nationwide indoor smoking ban took effect, a new study suggests. 

Scotland banned smoking in all enclosed public spaces and workplaces in 2006. There was a 17 per cent reduction in heart attacks in the first year after the ban took effect, compared to just a 4 per cent decline over the same period in England, where public smoking rules didn’t change, the study team notes. 

In Scotland between 2000 and 2016, there were a total of 117,161 heart attacks. 

Among men and women aged 60 and older, the smoking ban was followed by a roughly 13 per cent reduction in heart attacks over the study period. The ban didn’t appear to impact heart attacks for younger people, however. 

“People tend to start smoking when they are young, many years before they reach the age at which heart attacks tend to occur,” said Dr Jill Pell, director of the Institute of Health and Wellbeing at the University of Glasgow in the UK and coauthor of the study. 

“Therefore, any effect from discouraging people from starting to smoke is likely to take more time to become apparent,” Pell said by email. 

Even before the smoking ban, heart attack rates were declining in Scotland, the study team notes in Circulation: Cardiovascular Quality and Outcomes. But the legislation contributed to additional reductions, they conclude. 

In a previous study of the smoking ban, Pell and colleagues found a reduction in heart attacks among both smokers and non-smokers, she said. In a separate study, they also found that the number of smokers trying to quit increased immediately prior to the ban. 

While these studies were not designed to prove whether or how the ban directly prevented heart attacks, “there is likely to be a contribution from both encouraging smokers to quit and from protecting both non-smokers and smokers from other people’s secondhand smoke,” Pell said. 

Heart attack rates dropped slightly more for women over 60: 14 per cent versus 13.2 per cent for men. 

“In younger people overall, there appeared to be less of an impact across the 10-year period,” said Stephanie Mayne, a researcher at the Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania who wasn’t involved in the study. 

“This might be due to changes in other heart disease risk factors, like obesity and diabetes, during the same time period,” Mayne said by email. 

Even so, the results offer fresh evidence of the benefits of avoiding secondhand smoke and living in places where it’s not as easy to start or continue smoking, said Judith Prochaska, a researcher at Stanford University in California who wasn’t involved in the study. 

 “As much as feasibly possible, avoid exposure to secondhand smoke,” said Prochaska, who has received funding from Pfizer and Achieve, companies that make smoking cessation drugs. 

“If you live with someone who smokes, work to set up a policy to limit smoking to outside of the home and not in the car,” Prochaska said by email. “And if you live in an apartment complex that allows smoking, advocate for a change in policy.”