PASSIVE SMOKING: 30 MINUTES IS ENOUGH TO CAUSE OBSERVABLE CHANGES IN THE ARTERIES
PASSIVE SMOKING: 30 MINUTES IS ENOUGH TO CAUSE OBSERVABLE CHANGES IN THE ARTERIES
New scientific evidence on the damage caused by cigarettes reaffirms the importance of the Framework Convention on Tobacco Control
World Congress of Cardiology, Buenos Aires, 18th May 2008: Those who are habitually exposed to passive smoke run a cardiovascular risk almost as high as those who smoke; people who do not smoke but inhale second hand smoke suffer a 30% increased risk of cardiovascular disease. But the most alarming factor is the speed with which passive smoking damages the cardiovascular apparatus. Trials which will be discussed at the XVI World Congress of Cardiology have shown that 30 minutes’ exposure to tobacco smoke is enough for changes to occur in the arteries of the non-smokers which increase cardiac risk.
“We know that just 30 minutes’ exposure to second hand tobacco smoke is enough to produce an observable change in the arterial function of non-smokers,” states Dr. Joaquín Barnoya, Research Director of the Cardiovascular Surgery Unit of Guatemala and Professor at the Washington University of St. Louis, U.S.A. “Passive tobacco smoke directly damages the endothelium, which is the internal wall of the arteries, responsible for their dilation and contraction.”
The prevention of modifiable cardiovascular risk factors is the central subject of the XVI World Congress of Cardiology to be held in Buenos Aires from the 18th - 21st May 2008 and will be attended by around 15,000 professionals from more than 100 countries. The adverse effects of smoking and public policies to control it are a central topic of the most important scientific events in world cardiology.
Another significant advance in the understanding of the adverse effects of passive smoking is the finding that tobacco smoke contains substances whose pernicious effect on the arteries of non-smokers is not known. “These are mainly heavy metals like benzene or acroleine which cause oxidative damage to arterial endothelium and the mitochondria which is the cell breathing organ,” Dr. Barnoya explains and warns that: “the longer the arteries of non-smokers are exposed to tobacco smoke, the more they will behave like the arteries of smokers.”
Various trials have shown that passive smoking causes cardiovascular damage equal to 80% to 90% of the damage suffered by smokers. In the United States alone, 35,000 people die every year as a result of passive smoking. The World Health Organization (WHO) estimates that by 2025, the deaths associated to tobacco will have tripled; 70% will have occurred in undeveloped countries.
ENVIRONMENTS FREE FROM SMOKE
“New evidence confirms what is already known and helps to understand the rapid decrease of heart disease after the implementation of smoke free environments. In Italy, California (United States) and other parts of the world which have implemented smoke free environments, mortality and the incidence of heart infarcts has decreased rapidly,” says Dr. Joaquin Barnoya, Advisor on Tobacco Control at the Inter-American Heart Foundation.
Trials carried out in Italy and the United States have shown that already after 6 months’ prohibition of smoking in closed areas, there is a reduction of 11% to 13% in hospital admissions for acute myocardial infarction. “Now, with the new evidence we have on passive smoking, we can explain why there is such a marked reduction: it is because second hand tobacco smoke rapidly damages the arteries of non-smokers,” states Dr Barnoya.
In Uruguay, which ratified the Framework Convention on Tobacco Control (FCTC) of the World Health Organization (WHO) in 2004 and started implementing it in 2005, taking measures to forbid smoking in places of work and all public areas, advertising of tobacco products and the increase in taxes and price of tobacco, a 90% reduction of air pollution was observed in indoor areas.
“This was verified by measuring the presence of particles smaller than 2.5 by m3 (PM2.5) which are the most dangerous air pollutants because they are inhaled deeply and reach the alveoli and enter the circulation and the rest of the body,” Dr Eduardo Bianco, Director of the Tobacco Control Program of the Inter-American Heart Foundation and President of the Tobacco Epidemic Research Center (CIET) in Uruguay. “In 2005, average levels were 210PM2.5, whilst in bars levels reached a mean of 314PM2.5.”
The implementation in Uruguay of the measures of the Framework Convention on Tobacco Control, which has already been ratified by another 153 states, reduced air pollution in indoor areas and small particles to 24PM2.5, well below the 65PM2.5 which are the maximum level advised by international norms. “This makes Uruguay one of the countries with the best quality of air in indoor areas,” Dr Bianco concludes.
LEARNINGS FROM THE RAYUELA PROJECT
The need to implement public policies capable of confronting the problems of smoking was reflected in the results of the Rayuela Project (word in Spanish that means “hopscotch”) which will be discussed during the XVI World Congress of Cardiology. This initiative of the Argentine Foundation of Cardiology and the Argentine Federation of Cardiology implemented in public and private schools in the cities of Buenos Aires and La Plata in Argentina assessed the results of a program aimed at reducing the incidence of new smokers among 10 to 13 year old pupils.
Prior to starting the project which was based on games activities designed to enhance protection factors and reduce vulnerability to different risk situations for the health of teenagers, a survey of 1,676 initial participants showed that more than 60% of the pupils who had smoked or who were smoking could obtain tobacco without any restrictions in their usual sale points.
“Although the Rayuela Project failed in its attempt to reduce the incidence of new smokers, the analysis of results showed interesting aspects for the development of future intervention programs for teenagers,” Dr Maria Inés Sosa Liprandi, Co-Director of the Rayuela Project and the ARCONTA (Argentina against Tobacco Program) states.
“In the Argentine context, where cigarettes are very cheap, the advertising aimed at teenagers very aggressive and smoke free schools very few, we may conclude that making the implementation of school programs the starting point is not the most effective one for an integral tobacco control program,” she concludes.
The investigators of the Rayuela Project were also able to observe that the children most receptive to tobacco advertising were also the most susceptible to start smoking. “There is sufficient evidence on the factors that have an influence when smokers begin to smoke: product accessibility, family attitudes, group pressure, personal and educational factors and advertising” Dr. Sosa Liprandi says. “Among them the last seems to be directly responsible for recruiting the population (for tobacco consumption).”
The conclusions of this study provide new scientific evidence on the importance of the Framework Convention for Tobacco Control (FCTC) which points to key aspects to prevent teenagers starting smoking, observed in the Rayuela Project such as the prohibition of advertising tobacco products to which teenagers are particularly vulnerable.
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About the World Heart Federation
The World Heart Federation is a nongovernmental organization based in Geneva, Switzerland dedicated to the prevention and control of heart disease and stroke, with a focus on low- and middle-income countries. It comprises 196 member societies of cardiology and heart foundations from over 100 countries covering the regions of Asia-Pacific, Europe, East Mediterranean, the Americas and Africa.
www.worldheart.org and www.worldcardiocongress.org
The Argentine Society of Cardiology
The Argentine Society of Cardiology (SAC) was founded in 1937 and it is one of the world's oldest cardiological societies. Its members include many prestigious historical figures internationally recognized for their contributions to science including one Nobel Prize winner. SAC has more than 6,500 members in various categories including doctors, nurses and technicians. It has 36 Regional Districts spread over the entire national territory and 20 scientific councils representing all the subspecialties of cardiology. It conducts continuous and intensive teaching with courses in all subspecialties, grants the certification of “Universitary Cardiologist” and conducts a programme of recertification training.
Other important areas of its role include research, with epidemiological surveys, clinical research studies and the “Consensus” which sets standards for diagnosis and treatment of major cardiovascular diseases. The society acts as advisor to both legislative chambers of the national parliament and it has established a community focused institution, the Argentine Foundation of Cardiology, to educate and prevent cardiovascular disease as well as running and dictating courses on cardiopulmonary resuscitation.
www.sac.org.ar
The Argentine Federation of Cardiology
The Argentine Federation of Cardiology (FAC) is a scientific institution comprised of 37 cardiology organizations and 11 delegations from the Republic of Argentina. Its mission is to promote the harmonious and integrated development of Argentine cardiology to promote cardiovascular health. The Federation has 22 scientific committees with subspecialties devoted to research and scientific output.
FAC publishes a hierarchical Scientific Magazine and through its Educational Programmes, develops regular activity focusing on immediate post-graduate education.
It also works closely with the CARDIO Foundation dealing with subjects related to the prevention of cardiovascular diseases and health education in the community.
www.fac.org.ar