Good Air, Good Health: Scottish Smoking Ban Leads to Huge Drop in Heart Attacks

The Scots are notorious for their chronically low life expectancy. Many drink and smoke too much and their diet often leaves something to be desired -- and so they tend to die a few years before the average European. In Glasgow, for example, the average man does not need to worry about what he will do on his 71st birthday.

Health education campaigns costing millions of euros have nonetheless led to a decline in heart attacks over the last few years, at an annual rate of about 3 percent. But now it seems a miracle has happened: The number of heart attacks in Scotland has suddenly dropped by no less than 17 percent in a single year.

What has happened? Have the Scots stopped eating red meat? Has the whole country started knocking back cholesterol medication? Are they all training for the marathon?

No. The reason is much simpler: Scots are having fewer heart attacks because they are no longer inhaling other people's cigarette smoke when they sit in the pub, the train or the office.

Scientists at the University of Glasgow reported last week that things have become remarkably quiet in the country's heart clinics since smoking in public was banned in Scotland in March 2006. In nine selected Scottish clinics, 3,235 heart attack victims were brought in during the 10 months before the ban. In comparison, the number for the 10 months after the ban was only 2,684.

The Best Thing Since Sport

Now the Scots and the rest of the world are marvelling at 551 heart attacks that never happened -- simply because of cleaner air. How can pollutants with a relatively low concentration, inhaled during the occasional visit to the pub, have such a dramatic effect?

Many people in the United Kingdom have reacted incredulously to the surprising results, which make smoking bans appear to be the best and cheapest health measure since the invention of recreational sports. Some speculated that perhaps it was all to do with the weather, while the London Times recommended "healthy skepticism" in the face of the results.

But for medical experts, the Scottish study is actually not that surprising. There are already several studies from other countries which have yielded very similar results:

• The number of heart attacks in Ireland has fallen by about 11 percent since the smoking ban was introduced there in March 2004, Irish researchers announced at a cardiology congress in Vienna.

• Following the smoking ban introduced in Italy in January 2005, the number of heart attack victims under 60 in the Piedmont region also declined by 11 percent. Previously, the number had been on the rise for years.

• Residents of the city Pueblo in the US state of Colorado suffered 27 percent fewer heart attacks in the 18 months after a smoking ban was introduced in July 2003.

• The number of heart attacks suffered in the town of Helena in the US state of Montana even declined by about 40 percent following a 2002 smoking ban. However when a judge legalized smoking again six months later, the number of heart attacks returned to previous levels.

"The correlation between passive smoking and heart attacks is now excellently documented," says Tobias Raupach, the scientific director of an center for people who want to quit smoking at the University Medical Center Göttingen. The peculiar thing is that, both with passive and active smoking, a minimal change can already lead to a large effect. Much as with an avalanche, a small stimulus can lead to a cascade of events.

The likelihood that someone will get lung cancer rises in proportion to the number of cigarettes they smoke. But when it comes to heart attacks caused by cigarette smoke, there is no such linear correlation. Just a few hours of passive smoking lead to measurable changes in the blood.

"A very small amount of toxins can already cause great damage," says Raupach, adding that scientists are getting an increasingly clear picture of why that is so. The lung's reaction to the smoke means blood platelets can stick together more easily (see graphic). For people who are already close to suffering a heart attack, that can turn out to be the straw that breaks the camel's back -- or the Camel that sends them to the grave.

Every year, 275,000 Germans suffer heart attacks and about 150,000 of them die. If German hearts react to cigarette smoke the same way that Scottish ones do, then the smoking bans being introduced across Germany in 2007 and 2008 could help prevent as many as 47,000 heart attacks at one stroke.

The figure is hard to comprehend. Until now, not even sworn enemies of smoking believed that passive smoking could cause so much harm to so many people in Germany.