Why are smoking bans so good at cutting heart attack rates?

The battle to stop people from smoking in public places has been a long and hard one. Those of us who knew the impact that inhaling smoke could have on health have had to combat others who saw smoking as a right – no matter what the impact might be on others.
Now that bans are in place however, it is becoming clear that smoke-free legislation is one of the most effective health policies ever introduced in the UK in the past ten years.
The first legislation covered workplaces and its initial aim was to protect the health of the thousands of people in the UK who were then working in smoky atmospheres, and prevent the estimated 500 deaths caused by workplace exposure each year.
However, perhaps the most important legacy of that legislation was a step change in the acceptability of smoking in public – so that when the new rules about smoking in pubs, restaurants, shopping centres and the like came in, it achieved almost universal compliance.

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Just a couple of years after the change, most people wonder why we waited so long to do it. What most people, including many health professionals, didn’t realise was just how big the health benefits would be.
What early studies have shown is that, in the year or two after smoking bans are put in place, the number of hospital admissions for heart attacks falls by between one sixth and one quarter. Effects of this magnitude translate into the prevention of thousands of deaths each year in the UK. On this outcome alone, the smoke-free legislation has been a massive success.
What is the explanation for this reduction? First some sober facts. Smoking still kills around 100,000 people in the UK each year. Lung cancer remains the biggest killer, but in close second and third place come heart disease, and the combination of chronic bronchitis and emphysema now referred to as chronic obstructive pulmonary disease.
Stopping smoking at any age reduces the risk of dying from all of these conditions, but usually reductions in numbers of hospital admissions and deaths for lung cancer and COPD take years to materialise.
For heart disease, however the picture is very different. This is because when non-smokers inhale cigarette smoke it has a rapid and powerful impact on the blood clotting mechanisms involved in triggering heart attacks. What’s more these effects reverse within days after smoke exposure stops.
What this means is that avoiding tobacco smoke cuts the risk of a heart attack almost immediately – and it is this that has led to the marked reductions in hospital admissions and deaths.
The ban has also helped many smokers to give up their habit. In fact the smoke-free legislation, along with the tobacco advertising ban, media campaigns, NHS stop smoking services, and many other initiatives have all contributed to a near 30% reduction in UK smoking prevalence since 1997.
The health benefits and NHS costs saved are vast; indeed, one of the lasting legacies of the present UK government is that it has done more to tackle smoking than any other in history, making the UK a world leader in tobacco control.
However, smoking is still the biggest avoidable cause of death and disability, and of inequalities in health. Smoking is still ingrained in our society so that millions of adults and children are still exposed to tobacco smoke in the home.
Millions of children grow up in families and communities where smoking is the norm, and consignment to a life of addiction to tobacco, and to premature death from lung or heart disease, is a fact of life. Children still see tobacco products displayed prominently for sale in the shops they visit with their family and friends; millions of smokers are still denied a choice of more affordable, effective substitutes to smoking that, if not safe, are far less harmful that burning tobacco and inhaling the smoke.
Not all of these problems can be solved by measures so simple as smoke-free legislation, but many can. The success of going smoke-free shows just what can be achieved.