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ASH's Widely Copied Warnings About Heart Attack From 30 Minutes Exposure to Tobacco Smoke Vindicated By Recent Real-World Studies

Now Updated to Include New Indiana Study, see below

Action on Smoking and Health (ASH) was apparently the first and most frequently-quoted antismoking organization to warn the public that even 30 minutes of exposure to small amounts of drifting secondhand tobacco smoke can increase a nonsmokers' risk of a heart attack to that of a smoker, and can trigger a (sometimes fatal) heart attack.

“COULD EATING IN A SMOKY RESTAURANT precipitate an acute myocardial infarction in a non-smoker? . . ., a growing body of scientific data suggests that this is possible . . . laboratory data suggest that EVEN 30 MINUTES OF EXPOSURE to a typical dose of secondhand smoke induces changes in arterial endothelial function in EXPOSED NON-SMOKERS of a magnitude SIMILAR TO THOSE MEASURED IN ACTIVE SMOKERS.” How Acute and Reversible are the Cardiovascular Risks of Secondhand Smoke?, British Medical Journal [link], [emphasis added]. 

Indeed, the U.S. Surgeon General, in his report entitled SECONDHAND SMOKE, WHAT IT MEANS TO YOU, [link] has concluded and warned the public in no uncertain terms that:
■ “It hurts you, It doesn’t take much. It doesn’t take long.”
■ “There is NO SAFE AMOUNT OF SECONDHAND TOBACCO SMOKE.  Breathing even a little secondhand smoke can be dangerous.
■“People who have heart disease should be very careful not to go where they will be around secondhand smoke.”
■“The bottom line is that BREATHING SECONDHAND SMOKE MAKES IT MORE LIKELY THAT YOU WILL GET HEART DISEASE, HAVE A HEART ATTACK, AND DIE EARLY.
■ Even a  SHORT TIME IN A SMOKY ROOM causes your blood platelets to stick together. Secondhand smoke also damages the lining of your blood vessels. In your heart, THESE BAD CHANGES CAN CAUSE A DEADLY HEART ATTACK [emphasis added]

Now a number of major studies  – in Helena [MO], Pueblo [CO], New York State, Piedmont [Italy], Ireland, and Scotland – have consistently shown a major decrease in hospital admissions for heart attacks after smokefree laws went into effect, and, at least in the case of Helena, a dramatic re-increase in heart attacks after the ban was dropped.  This is very compelling real-world proof that even brief exposure to secondhand tobacco smoke can trigger heart attacks, and also of the enormous saving in both lives and health care costs from smoking bans.
 
For example, the recent study from New York shows that the decline was equivalent to 3,813 fewer hospital admissions for heart attacks.  At an average cost of $14,772 for each heart-attack admission, the total savings is about $56.3 million – a saving achieved at virtually no cost. [link]

An even more recent study in Indiana found:

People with no risk factors for heart disease can still experience heart attacks. An Indiana University study found that after a countywide smoking ban was implemented, hospital admissions for such heart attacks dropped 70 percent for non-smokers -- but not for smokers.  . . .  Exposure to second-hand smoke FOR JUST 30 MINUTES can rapidly increase a person's risk for heart attack, even if they have no risk factors. The smoke, which contains carbon monoxide, causes blood vessels to constrict and reduces the amount of oxygen that can be transported in the blood. [link] [study][emphasis added]

To explain how even brief exposure to secondhand tobacco smoke can cause fatal heart attacks, a researcher explained:

Indeed, as Professor (of Cardiology) Stanton A. Glantz, one of the leading researchers in the area – and one who HAS done and published actual peer-reviewed articles about his experiments regarding this risk – has summarized it:

"There is strong and convincing evidence, from a wide variety of studies, that EVEN BRIEF EXPOSURE to secondhand smoke leads to blood and blood vessels behaving SIMILAR TO THAT OBSERVED IN CHRONIC SMOKERS. While 30 minutes of SHS exposure does not precipitate a heart attack in every nonsmoker, it does, among other things, activate platelets and depress function of the vascular endothelium (the lining of arteries) in a way that is known to trigger a heart attack in people at risk.  These are precisely the immediate effects that anti-platelet drugs like aspirin are designed to prevent.” [emphasis added]

He cites:
■ 1. Barnoya J, Glantz SA. Cardiovascular effects of secondhand smoke: nearly as large as smoking. Circulation [link]
■  2. Pechacek TF, Babb S. How acute and reversible are the cardiovascular risks of secondhand smoke? BMJ  [link]
■ 3. Raupach T, Schafer K, Konstantinides S, Andreas S., Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm. European Heart Journal [link]
■ 4. Venn A, Britton J. Exposure to secondhand smoke and biomarkers of cardiovascular disease risk in never-smoking adults. Circulation [link]

Professor of Cardiology Stanton Glantz is also now reporting that:

"Breathing secondhand smoke FOR JUST THIRTY MINUTES affects blood and blood vessels, including the vital coronary arteries, AS MUCH AS BEING A SMOKER. Two hours of secondhand smoke exposure compromises control of the heart beat, boosting the risk of irregular beats (and SUDDEN DEATH) or a heart attack. Because of these effects, someone in a  restaurant who is at risk of a heart attack when secondhand smoke is in the air will be more likely to have a heart attack.” [emphasis added]

Prof. Glantz has also explained that there are several different cardiovascular effects which may be involved, but that the one reported by Dr. Otsuka in his study [link] is probably not the most important (as some have suggested):

Tobacco smoke has both short term (acute) and long term (chronic) effects.  The long term effects, mostly related to oxidant loads and effects on LDL cholesterol play a role in the slow development of atherosclerosis.  The immediate physical damage that activated platelets (activated by SHS) do to the lining of the coronary arteries (the vascular endothelium) is important to allowing the atherosclerotic process to begin. The changes in endothelial reactivity that Otsuka (and lots of others) are probably not central to this process.
The effects that Otsuka and many others have documented relate to the acute changes in vascular function which are probably more important in terms of what SHS [second hand smoke] does in terms of causing heart disease.  The IMMEDIATE EFFECTS (WITHIN MINUTES) on platelet activation and endothelial function (Otsuka deals with endothelial function) are associated with thrombus formation and ACUTE PLAQUE RUPTURE as well as the ability of arteries to respond to these insults. 
It is THESE IMMEDIATE EFFECTS THAT ARE ASSOCIATED WITH INCREASED SHORT TERM RISK OF HEART ATTACKS DUE TO BOTH SECONDHAND SMOKE EXPOSURE and air pollution. (It is why, in particular, there are more heart attacks on polluted days.)  It is PRECISELY THE "MEASURABLE EFFECTS ON THE LINING OF CORONARY ARTERIES" THAT CAN TRIGGER HEART ATTACKS.
The UNDERLYING BIOLOGY THAT SUPPORTS THESE CONCLUSIONS IS EXTENSIVE and forms the basis for much of what is done to treat and prevent heart attacks (such as taking aspirin or other anti-platelet agents).

Fortunately, more than 100 other independent medical and antismoking organizations have so far followed ASH’s lead, and are now warning their members, the public, legislators, regulators, and others about how as little as 30 minutes exposure to tobacco smoke can trigger a fatal heart attack.  In most cases these organizations issued their own similarly-worded warnings only after independently reviewing the underlying evidence – often with the assistance of their own expert scientific and medical advisors – and concluding, even though the warnings were very dramatic and may be very difficult for some people to accept, that they are fully warranted, appropriate, and necessary.  This shows that despite a few deniers – just like those who still deny that the HIV virus causes AIDS, that Americans ever landed on the moon, or that smoking (active or passive) causes cancer – there is a strong and ever-growing consensus in the scientific and medical communities that brief exposure to secondhand tobacco smoke causes heart attack deaths.

These independent organizations have not been deterred by the underhanded efforts of big tobacco, those affiliated with it, and others to distort and misrepresent the evidence about the adverse effects of secondhand tobacco smoke on cardiovascular diseases, nitpick the precise wording of the warnings, point out alleged loopholes or problems with the studies, or attack the researchers for bias, just as the tobacco industry did unsuccessfully in the past in trying to persuade the public that secondhand tobacco smoke didn’t cause lung cancer in nonsmokers, or even that smoking itself didn’t cause heart attacks or lung cancer in smokers. 

For a recent study documenting how big tobacco and those in league with it try to misrepresent and distort the facts and public opinion about how secondhand smoke causes heart attacks, see:
■  TOBACCO INDUSTRY DECEIT CLAIMED – Study Says Firms Tried to Suppress Dangers of Secondhand Smoke, Sacramento Bee [10/16] [link] AND
■  UC Study Uncovers Tobacco Industry Efforts to Undermine Secondhand Smoke Link to Cardiovascular Disease [10/15] [link]

CONCLUSION: In view of all of this evidence from a wide variety of sources, including the federal government, all nonsmokers should avoid to the extent possible even brief exposure to drifting tobacco smoke in restaurants, bars, and other public places since it dramatically increases their risk of suffering a heart attack – possibly a fatal heart attack – triggered by the inhalation.

This is especially true for all those at increased risk for heart attacks, including men over 40, post-menopausal women, anyone who is obese or gets insufficient exercise, anyone with diabetes or a variety of other medical problems, anyone with a personal or family history of heart or other cardiovascular problems, etc.  Since many people may have a compromised cardiovascular system – or other heart and circulatory problems – and may not be aware of it, everyone should heed all of these warnings, even if the warnings are targeted especially to those with heart problems.

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