Smokefree laws and higher tobacco taxes in India could prevent nine million heart disease and stroke deaths over the next decade, a new study says.

The findings suggest that these tobacco control strategies would be substantially more effective than pharmacological interventions for reducing deaths from cardiovascular disease.

Cardiovascular diseases (CVD) – those that affect the heart or the blood vessels – are the leading cause of death worldwide, with over 80 per cent of deaths occurring in low- and middle-income countries. Tobacco use is a major risk factor for CVD.

Researchers from Stanford University, University of California San Francisco, Harvard Medical School and Imperial College London used a mathematical model to investigate which tobacco control measures could best reduce the burden of CVD in low- and middle-income countries. Their model estimated the effects of various tobacco control measures and pharmacological therapies on deaths from heart attack and stroke in India between 2013 and 2022.

The study, published in PLOS Medicine, compared five different tobacco control measures: smokefree legislation, tobacco taxation, provision of brief cessation advice by healthcare providers, mass media campaigns, and advertising bans. It also examined the effects of increasing access to aspirin, antihypertensive drugs, and statins.

The authors conclude that, based on their model, smoke-free legislation and tobacco taxation are expected to be the most effective strategies for reducing heart attack and stroke deaths over the next decade. These two measures alone could prevent about nine million deaths from heart attack and stroke in India by 2022, and a combination of tobacco control policies and pharmacological interventions could prevent even more deaths.

“One of the advantages of using large-scale surveys to inform these models,” said lead author Sanjay Basu of Stanford University, “is that we can account for unique populations who have different risk factors from places like the United States and the United Kingdom. For example, many Indians smoke informal cigarettes called ‘bidis’ which are highly risky to health but are often missed by standard models focusing only on manufactured cigarettes.”

“These findings highlight the importance of accelerating implementation of WHO-recommended policies in India, especially increasing tax on tobacco products and having smokefree public places” said Dr Christopher Millett from Imperial College London and the Public Health Foundation of India.

Reference

S Basu et al. ‘The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke’ PLOS Medicine, 2013.