USA: Study Finds That Heart Attacks I...

USA: Study Finds That Heart Attacks In Non-smokers Decreased With Smoking Ban

There are 17 comments on the MediLexicon story from Nov 20, 2007, titled USA: Study Finds That Heart Attacks In Non-smokers Decreased With Smoking Ban. In it, MediLexicon reports that:

“What concerns us is the fact that about half of all non-smoking Americans are regularly exposed to secondhand smoke, even though more than 500 municipalities nationwide have adopted some form of a smoking ban in public places.”

People with no risk factors for heart disease can still experience heart attacks. via MediLexicon

Join the discussion below, or Read more at MediLexicon.

Since: Nov 07

UK

#1 Nov 20, 2007
"An Indiana University study found that after a countywide smoking ban was implemented, hospital admissions for heart attacks dropped 70 percent for non-smokers, but not for smokers."

70%!!!!!!!!!

I believe this is the first study that discriminates between smokers and non-smokers with regards heart attacks. A 70% drop in heart attack admissions in non-smokers coinciding with the introduction of new smoking regulations?

Darn these inconvenient coincidences!
MRab2

UK

#2 Nov 20, 2007
Eric, we've been seeing similar studies come out for a while, beginning, I believe, with the Helena study.
They've all been debunked.

The one in Scotland, you know, the one where the results were released but the study never was, was just shot full of holes by the offical figures that covered ALL of Scotland and not just a few well selected hospitals.

Another one in the US was compared with the figures from a neighbouring state that DIDN'T have a smoking ban and guess what; the smoking friendly state saw a GREATER drop in heart attack rates.

IIRC THIS study is based on... 22 heart attacks. A whole 22. Even the unscientific such as yourself MUST agree that the sample size is a little on the small side.

Of course I'm fairly sure that the authors know, as I do, that most people won't read past the headlines.
Smoke Stack

Seaford, DE

#3 Nov 20, 2007
More BS not worth my time...
DryCow

Shelton, CT

#4 Nov 20, 2007
PU!
Such blatant BS
Justined

Carlisle, PA

#5 Nov 20, 2007
The Rest of the Story by DR. MICHAEL SIEGEL

To be blunt, this study is crappy and its conclusions are completely invalid. This study would never have passed scrutiny with me had I been asked to review it.

In fact, the results of the study fail to support the paper's conclusion.

While the press release sounds quite impressive, if you take the time to read the actual study, you'll find that the sweeping conclusion that a smoking ban reduced heart attacks among nonsmokers by 70% is based on a total of only 22 heart attacks. That's right. There were only 22 heart attacks among nonsmoking patients in Monroe County in this study between August 2001 and May 2005. And there were only 15 heart attacks among smoking patients in Monroe county during the study period.

The sample size of the study is so small that it is ridiculous to conclude that the observed decline from 17 heart attacks (2001-2003) to 5 heart attacks (2003-2005) was attributable to the smoking ban. With sample sizes this small, the variation in the number of annual heart attacks is expected to be enormous. There is no way that the study can determine that the observed decline was due to the smoking ban, rather than simply to random variation in the number of heart attacks in this small geographic area (only one hospital was included in the study).

More importantly perhaps, if you look at the results, you'll see that there is no significant difference between the change in heart attacks in Monroe versus Delaware counties over the study period. The confidence intervals around the estimates of the change in heart attacks in the two counties overlap widely. Based on the reported confidence intervals, the decline in heart attacks in Monroe County could be as low as 3, and the decline in heart attacks in Delaware County could be as high as 13. In other words, it is entirely plausible, based on the study findings, that the decline in heart attacks in Delaware County was greater than that in Monroe County.

These results make it clear that there is no significant difference in the change in heart attacks between the two counties over the study period, thus nullifying the study conclusion.
just candid

AOL

#7 Nov 20, 2007
DryCow wrote:
PU!
Such blatant BS
Welcome back Indian lady,we have missed you and your lengthy, caustic comments. LOL Keep enjoying life and have a great Thanksgiving !
Smoke Free

Lake Mary, FL

#8 Nov 20, 2007
Justined wrote:
The Rest of the Story by DR. MICHAEL SIEGEL
To be blunt, this study is crappy and its conclusions are completely invalid. This study would never have passed scrutiny with me had I been asked to review it.
In fact, the results of the study fail to support the paper's conclusion.
While the press release sounds quite impressive, if you take the time to read the actual study, you'll find that the sweeping conclusion that a smoking ban reduced heart attacks among nonsmokers by 70% is based on a total of only 22 heart attacks. That's right. There were only 22 heart attacks among nonsmoking patients in Monroe County in this study between August 2001 and May 2005. And there were only 15 heart attacks among smoking patients in Monroe county during the study period.
The sample size of the study is so small that it is ridiculous to conclude that the observed decline from 17 heart attacks (2001-2003) to 5 heart attacks (2003-2005) was attributable to the smoking ban. With sample sizes this small, the variation in the number of annual heart attacks is expected to be enormous. There is no way that the study can determine that the observed decline was due to the smoking ban, rather than simply to random variation in the number of heart attacks in this small geographic area (only one hospital was included in the study).
More importantly perhaps, if you look at the results, you'll see that there is no significant difference between the change in heart attacks in Monroe versus Delaware counties over the study period. The confidence intervals around the estimates of the change in heart attacks in the two counties overlap widely. Based on the reported confidence intervals, the decline in heart attacks in Monroe County could be as low as 3, and the decline in heart attacks in Delaware County could be as high as 13. In other words, it is entirely plausible, based on the study findings, that the decline in heart attacks in Delaware County was greater than that in Monroe County.
These results make it clear that there is no significant difference in the change in heart attacks between the two counties over the study period, thus nullifying the study conclusion.
MICHAEL SIEGEL is a F'n Quack. He talks out of both ends. A few years ago people with authority would listen to him, but he has gone off the deep end and is now considered a fanatic at best. He's like a Cult Leader, smokers are desperate and he sees the money coming in from these loons and loving it. Soon he'll be serving a special tobacco flavored Kool-Aide, look out smokers he's looking to buy a ranch in Waco too!!!
Kent

Great Cacapon, WV

#9 Nov 20, 2007
Smoke Free is a F'n Quack. He talks out of both ends. Nobody with any authority would ever listen to him. He has gone off the deep end and is now considered a fanatic at best. He's like a Cult Leader, anti-smokers are desperate and he sees the stench coming in from these goons and loving it. Soon he'll be serving a special road apple flavored Kool-Aide, look out anti-smokers he's looking to buy a ranch in Waco too!!!
Have a nice day
Anonymouse

Kitchener, Canada

#10 Nov 20, 2007
Smoke Free wrote:
<quoted text>
MICHAEL SIEGEL is a F'n Quack. He talks out of both ends. A few years ago people with authority would listen to him, but he has gone off the deep end and is now considered a fanatic at best. He's like a Cult Leader, smokers are desperate and he sees the money coming in from these loons and loving it. Soon he'll be serving a special tobacco flavored Kool-Aide, look out smokers he's looking to buy a ranch in Waco too!!!
Poor Mike Siegel seems to have lost friends in the public health area and is now cozy with some strange smokers' rights loons. Take note that the propaganda that Justined cut and pasted is from that strange forces.com site.
enough

Indianapolis, IN

#12 Nov 20, 2007
Anonymouse wrote:
<quoted text>
Poor Mike Siegel seems to have lost friends in the public health area and is now cozy with some strange smokers' rights loons. Take note that the propaganda that Justined cut and pasted is from that strange forces.com site.
So a sample size of 22 is fine? Or is it only if it shows a difference that you agree with? Good job of attacking the messenger. Next time focus on the message.
enough

United States

#13 Nov 22, 2007
enough wrote:
<quoted text>
So a sample size of 22 is fine? Or is it only if it shows a difference that you agree with? Good job of attacking the messenger. Next time focus on the message.
You know Peter, you're really good at starting new posts saying "Congratulations to the good people of City X for enforcing a smoking ban", but you're lousy at responding to direct questions.
Bill Hannegan

United States

#14 Nov 23, 2007
An interesting letter in BMJ on heart attack studies:

http://www.bmj.com/cgi/content/full/328/7452/...
Anonymouse

Kitchener, Canada

#15 Nov 23, 2007
Here's another interesting study on the damage done by second hand smoke damaging the heart.

http://www.foxnews.com/story/0,2933,312600,00...
enough

United States

#16 Nov 23, 2007
Anonymouse wrote:
Here's another interesting study on the damage done by second hand smoke damaging the heart.
http://www.foxnews.com/story/0,2933,312600,00...
Wait, what???

"Mice solely fed a liquid diet containing ethanol had a 3.5-fold increase in artery lesions when compared to mice fed a normal diet."

An 3.5x increase in artery lesions when mice are switched from normal diet to the diet including alcohol doesn't exactly jibe with Dr. Bailey's assertion that "moderate alcohol consumption is commonly thought to be cardioprotective" - the increased risk from +alcohol leads to 50% more arterial lesions than +SHS (2.3x).

Granted, that probably wasn't the PC conclusion that the reporter was aiming for, so there was no follow-up on that inconvenient truth.

---

Pete, c'mon - 22 heart attacks over 22 months. That's a big enough sample size to draw a conclusion from?
enough

United States

#17 Nov 25, 2007
enough wrote:
<quoted text>
An 3.5x increase in artery lesions when mice are switched from normal diet to the diet including alcohol doesn't exactly jibe with Dr. Bailey's assertion that "moderate alcohol consumption is commonly thought to be cardioprotective" - the increased risk from +alcohol leads to 50% more arterial lesions than +SHS (2.3x).
Enough with the drive-by postings, Mouse. You posted that link as if it meant something. It says that SHS induces arterial plaques in mice, but it also says that mice who were fed moderate amounts of alcohol were more likely to develop plaques than their SHS-exposed counterparts.

You don't think that's an interesting finding?
Justined

Myerstown, PA

#18 Nov 26, 2007
The facts in the way of a good story

BY: Michael Blastland

It looked like a vindication of the smoking ban in Scotland - in little more than a year, the heart attack rate had been cut by almost a fifth.

But look at official figures, says Michael Blastland, and it just doesn't stack up.

It was dramatic research that made headlines everywhere. A 17% fall in the number of heart attacks in the year since Scotland stubbed out smoking in public places.

Startling - if true.

Few questioned the research when it was revealed two months ago. Politicians trumpeted the numbers as vindication of a policy introduced a year earlier than in England. Journalists obediently followed suit.

The most arresting finding was that heart attacks among non-smokers had apparently fallen even faster than smokers, suggesting that passive smoking was often to blame.

Then a week ago, with rather less fanfare, routine statistics on hospital activity were published by the official source for health data in Scotland, as they are every year, this time including the time since the ban.

These show a fall in heart attacks for the year from March 2006 - not of 17%, but less than half as much at about 8%.

What's more, taking out the recent trend, this is halved again. Heart attacks have been falling steadily for some years now. The percentage falls in the three years before the ban were 5.1%, 4.7% and 5.7%. So the fall since is still bigger than the trend would lead us to expect, but bigger only by about three or four percentage points - an improvement, but retreating fast from the magnitude of 17.

The latest release also makes clear that even an 8% fall in heart attacks is not unprecedented. There was another, larger drop between 1999 and 2000 of about 11%(see chart).

This seems to demonstrate significant variability around the trend, suggesting that last year's 8% drop might even be the result of chance. It is conceivable, although perhaps unlikely, that the smoking ban had no effect at all. The figures could be a result of no more than the ordinary ups and downs of statistical variation from one year to the next.
Justined

Myerstown, PA

#19 Nov 26, 2007
CONTINUED:

There have been several other initiatives designed to reduce heart attacks in Scotland recently, and any or all might also have played a part.

If we look at all heart attacks, rather than just emergency admissions, the fall last year according to the official data was slightly smaller again - about 7%- against falls in the past three years on this measure typically of about 4%.

Rise and fall

Scotland's deputy chief medical officer, Peter Donnelly, said at the time of the study in September: "One of the most important findings is the reduction in heart attacks. We believe that the smoking ban was a large contributory factor to this drop."

It is not clear on what evidence he could now make such a claim. Any claims of causation now look premature. Even the latest figures are provisional and subject to revision.

Such claims are, in fact, positively damaging.

What is unquestionably a good news story - the consistent and impressive decline in heart attacks in Scotland over many years - has become overshadowed by squabbles about the smoking ban.
Worse, the true reasons for this success may be overlooked if too much credit is attributed to the ban on unreliable evidence.

So why such a discrepancy between the two numbers?

The first study was presented at a conference in Edinburgh two months ago by a research group called StopIt (Study Of Public Place Intervention on Tobacco Exposure).

The latest statistics come from ISD Scotland, part of the NHS responsible for health data. Dr Colin Fishbacker, an ISD official, says the two studies used data from different sources. "We wouldn't expect the sources to agree exactly. The routine data we publish is based on the discharge summary sent to the GP and medical records for coding. The StopIt study was a specific research exercise."

Numbers game

There are other factors that may might help explain the discrepancy. The first study, unlike the routine data, was a sample, not a total for all Scotland. And although the sample included nine Scottish hospitals with about two-thirds of heart attack admissions, patients did not have to take part.

There is also a suggestion that the StopIt study compared 10 months before the ban in March 2006, with 10 months after. So the two periods might have spanned different parts of the year. It paid particular attention to distinguishing between smokers and non-smokers, and this may have affected the way the study was carried out.

But because the data on which the StopIt study was based has never been published, and nor has the study itself, it is impossible to say exactly how it was done. Attempts to obtain it or to talk to the lead researcher have gone unanswered.
Once the number was out, politicians were certainly not about to exercise any scientifically-minded reservations about its reliability. The story became political as much as medical.

None of this rules out the possibility that the ban is having an effect. Such a conclusion would be as reckless as declaring that the ban explains everything. But how much effect it's having - if any - no-one knows.

As for the flurry of excitable headlines, what appeared to be hard medical evidence now looks more like over-hasty and over-confident research, coupled with wishful political thinking and uncritical journalism. Whether the same will happen now attention has shifted to the effect of the bans in England and Wales remains to be seen.

Michael Blastland is the author, with Andrew Dilnot, of The Tiger that Isn't - Seeing Through a World of Numbers.

http://news.bbc.co.uk/1/hi/magazine/7093356.s...

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