Workplace Smoking Bans Appear to Reduce Heart Attack Rate

A Minnesota county’s ban on smoking in all workplaces including restaurants and bars was associated with a dramatic drop in heart attack rates.

Banning smoking in all workplaces including restaurants and bars is associated with a substantial drop in heart attack rates, according to the results of a study published online in October 2012 in Archives of Internal Medicine.

The study focused on the effects of 2 ordinances in Olmsted County, Minnesota. The first, implemented in 2002, banned smoking in restaurants but not bars or other workplaces, and the second, implemented in 2007, banned smoking in all workplaces including bars. The researchers used data from the Rochester Epidemiology Project on the incidence of first heart attack and sudden cardiac death in the 18-month period before and after each of the ordinances was implemented.

Their results showed that in the 18 months after the 2007 ordinance was implemented, the age- and sex- adjusted rate of heart attack declined by 33% compared with the 18 months before the 2002 ordinance was implemented, from 150.8 to 100.7 per 100,000 people. During this same period, the age- and sex-adjusted rate of sudden cardiac death declined by 17%, from 109.1 to 91.0 per 100,000 people.

Over the period covered by the study, the prevalence of smoking declined, from 19.8% in 2000 to 14.9% in 2010, based on statewide self-reported data. Some of this decline may have been due to the workplace smoking bans, but a number of other tobacco-control efforts may have played a role as well, including: a 2001 media campaign geared toward helping smokers quit, a 2004 to 2007 media campaign emphasizing the hazards of secondhand smoke, a state tax of $0.75 per pack of cigarettes imposed in 2005, and a federal tax of $0.62 per pack of cigarettes imposed later.

At the same time, other cardiovascular risk factors such as hypertension, diabetes, high cholesterol, and obesity remained constant or increased, indicating that reduced exposure to cigarette smoke was a key driver of the decline in heart attack and sudden cardiac death rates. In turn, the researchers argue that the smoke-free workplace laws played a critical role in reducing exposure to cigarette smoke. As they note, the laws help reduce the intensity of smoking among smokers, increase quit rates, reduce uptake of smoking by teenagers, and reduce exposure to secondhand smoke.

The researchers argue that their findings, along with similar findings in other studies, show that secondhand smoke exposure should be considered a modifiable risk factor for heart attack. For this reason, everyone should avoid it insofar as possible, especially those with coronary heart disease.