CDC warns of risk from secondhand smoke

By Marc Kaufman
The Washington Post

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WASHINGTON — For the first time, the Centers for Disease Control and Prevention is warning people at risk of heart disease to avoid all buildings and gathering places that allow indoor smoking.

In commentary to a study in the British Medical Journal released yesterday, the CDC said doctors need to advise people with heart problems that secondhand smoke can increase their risk of a heart attack significantly. The agency said as little as 30 minutes' exposure can have a serious and even lethal effect.

The commentary accompanied a study showing that the number of heart attacks in Helena, Mont., decreased substantially after the city banned indoor smoking, then increased quickly back to its former level after the law was struck down in court.

That study found that during the six-month period in 2002 when the ban was in effect, the number of heart attacks reported by Helena's single heart hospital fell by 40 percent.

In his commentary, Terry Pechacek, associate director of science at CDC's Office on Smoking and Health, wrote that the research underscores evidence that secondhand smoke rapidly increases the tendency of blood to clot, which can restrict flow to the heart.

Pechacek said the new study strengthens the growing body of research pointing to potentially fast and acute reactions to secondhand smoke, in addition to long-term damage done to nonsmokers who live with smokers. The CDC has estimated that secondhand smoke causes 35,000 heart-disease deaths a year in the United States, but Pechacek said that estimate is likely to be revised upward.

"We've said before that secondhand smoke increases the risk of heart disease in nonsmokers, but this is our first recommendation that clinicians advise their patients with heart disease to avoid indoor settings where smoking is allowed," he said. "We don't make these kind of statements lightly. What we are seeing in the data is a substantial biological change that occurs with even 30 minutes of exposure to secondhand smoke."

The new CDC recommendation is bound to become part of the often acrimonious national debate over whether smoking in public places should be banned. Public-health advocates say the bans will save many lives, while cigarette makers and some businesspeople say the decision should be left to individual choice.

The Kentucky Supreme Court yesterday upheld a ban on smoking in bars, restaurants and other public places in Lexington, ruling that the city had acted within its authority to "promote and safeguard public health."
 
As both the CDC and authors of the new study acknowledge, the Montana data are limited by the relatively small number of people involved. Pechacek said that similarly dramatic reductions in heart attacks are unlikely to be found in larger populations, but he said the study is important because it offers the best real-world information to date on the connection between indoor smoking and serious heart problems. He said studies have been proposed or begun into how indoor-smoking bans in California, New York and Delaware have affected heart-attack rates.

The study's authors, Richard Sargent and Robert Shepard of St. Peter's Community Hospital in Helena, and Stanton Glantz of the University of California, San Francisco, collected information about the number of heart attacks from St. Peter's hospital records.

During the six-month period in 2002 when the indoor-smoking ban was in effect, 24 Helena residents suffered acute heart attacks. For the five years before and after 2002, the average number of heart attacks reported for Helena residents during the same six months was 40. The authors found through St. Peter's records that the number of heart attacks suffered by people living in the area outside Helena — where there was no smoking ban — did not experience the same 2002 dip as Helena.

Of patients in the study, 38 percent were current smokers, 29 percent were former smokers, and 33 percent never had smoked.

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