Smoking bans dramatically reduce the number of people hospitalised for heart attacks, stroke and respiratory diseases such as asthma and emphysema, new research has shown.

In the largest analysis of smoke-free legislation to date, American researchers found the more stringent the laws, including those for workplaces, restaurants and bars, resulted in the highest health benefits. 

The research, published in the American Heart Association journal Circulation, analysed 45 studies covering the US and other countries such as New Zealand and Germany.

It found heart attack hospitalisations declined by an average of 15 per cent after communities passed laws banning smoking in areas such as restaurants, bars and workplaces.

Admissions for strokes declined by 16 per cent, while hospitalisations for respiratory diseases such as asthma and chronic obstructive pulmonary disease, were rapidly followed by a 24 per cent decrease in hospitalisation.

Exposure to cigarette smoke induces rapid changes in blood chemistry, making it much more prone to clotting. 

In someone who has narrowed or damaged coronary arteries, smoke exposure can tip the balance and cause a heart attack.

The findings are consistent with other studies that have found smoking bans are linked with a decline in cardiac problems.

Department of Health figures found the number of heart attacks in England plummeted by 10 per cent in the year after the ban was imposed in July 2007.

A similar drop was also recorded in Scotland where another study discovered a 14 per cent decrease in the year after the ban was introduced there.

Around 114,000 people die every year from smoking-related diseases.

But while many link smoking to lung cancer, the connection between it and heart attacks is less well known. About 275,000 people suffer heart attacks in Britain each year, with 146,000 of those dying.

Commenting on the research, Maureen Talbot, senior cardiac nurse at the British Heart Foundation (BHF), said: ‘The risks of passive smoking on our health are well known and this is the reason smoking legislation was introduced throughout the UK in 2007. 

‘Restrictions on smoking in public can help smokers to cut down or quit as well as reducing our exposure to second hand smoke. 

‘This study provides encouraging data about the benefits of a smoke-free environment on our heart health and shows that the right decision was made five years ago. 

‘If we want this downward trend to continue, policy makers should introduce further measures to reduce the appeal of smoking, such as plain, standardised packaging for tobacco.’

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According to the American Heart Association, PAD involves a narrowing of the peripheral (outside the heart) arteries, most commonly the vessels of the pelvis or legs. People with PAD are at increased risk for heart attack, stroke or mini-stroke. The condition is thought to affect 8 million to 10 million people in the United States.

The new study included nearly 45,000 U.S. men who were followed for more than two decades. During that time, 537 cases of PAD were diagnosed. Each of the four risk factors — smoking, diabetes, high blood pressure (hypertension) and high cholesterol levels — was significantly and independently associated with a higher risk of PAD.

Ninety-six percent of the men who developed PAD had at least one of the four risk factors when they were diagnosed with theartery disease, noted a team led by Michel Joosten of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

The investigators also found that men who did not have any of the four risk factors were 77 percent less likely to develop PAD than all other men in the study.

The risk of PAD tended to increase the longer a man had both type 2 diabetes and high cholesterol levels, the researchers added.

Two experts welcomed the results of the study.

“This important study is consistent with findings from earlier studies,” noted Dr. Kenneth Ong, acting chair of the department of medicine and cardiology at the Brooklyn Hospital Center in New York City. “It is well done due to its large population and long duration of follow-up.”

Dr. Maja Zaric, an interventional cardiologist at Lenox Hill Hospital in New York City, who treats many patients with PAD, also noted that risk factors associated with the artery disease are also typically linked to heart disease, but the relationship to PAD seems to be even stronger.

That’s especially true for smoking, Zaric said. “As a matter of fact, one of the study findings reports remote effects of smoking on PAD incidence even 20 years after smoking cessation,” she pointed out. “That should not discourage smokers from abstinence since the PAD risk amongst current smokers appears to be threefold higher than in former smokers.”

Zaric added, “now that the major risk factors for PAD in men have been identified, additional studies with specific clinical endpoints should be done to examine effects of risk factor and lifestyle modification. And not to forget, women should be studied in a similar fashion, as it is shown that presence of PAD amongst female patients had been under-recognized.”

The study was published in the Oct. 24/31 issue of the Journal of the American Medical Association.

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