Influence of smoking on incidence and prevalence of peripheral arterial disease

Maastricht University, Maestricht, Limburg, Netherlands
Journal of Vascular Surgery (Impact Factor: 3.02). 01/2005; 40(6):1158-65. DOI: 10.1016/j.jvs.2004.08.049
Source: PubMed


Many studies have been published regarding the influence of smoking on the incidence and prevalence of peripheral arterial disease (PAD). A systematic review was performed to establish the magnitude of the effect of smoking on the development of PAD, and a possible dose-response relationship.
English-language articles were reviewed by 2 observers using a standardized form, and were summarized in tabular form. Data were extracted by 2 independent observers. Where possible, outcome data, expressed in terms of prevalence or incidence, were recalculated as odds ratio or relative risk, with never-smokers as the reference group, or if this was not available the nonsmoker group. Most studies did not provide primary data. Therefore the weighted means were reported as a summary estimate, provided that a funnel plot between sample size and observed effect size made publication bias unlikely.
Sixteen articles describing 17 studies were included in the analysis. Four of the studies were prospective, and 13 were cross-sectional. The prevalence of symptomatic PAD was increased 2.3-fold in current smokers. Even in former smokers the prevalence was substantially increased by a factor of 2.6. A clear dose-response relationship, with a strong increase in risk for PAD in heavy smokers was observed. In countries where approximately 30% of the population are smokers, 50% of PAD can be attributed to smoking.
Smoking is a potent risk factor for symptomatic PAD, with an important and consistent dose-response relationship. With the persistence of high risk for PAD in former smokers, tobacco control programs should continue to advocate smoking cessation, but focus even more on preventing future generations from ever starting to smoke.

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Available from: Edith M Willigendael,
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    • "Cigarette smoking leads to heart attacks, strokes, chronic obstructive pulmonary disease, and cancer. It also causes peripheral vascular disease, hypertension, and gastrointestinal disorders (Willigendael et al., 2004; Wright et al., 2005; Hogg and Timens, 2009; Hymowitz, 2011; Leone, 2011; Chu et al., 2013). In the United States, smoking is the leading cause of morbidity and mortality, accounting for 30% of all cancer deaths and 80% of deaths from chronic obstructive pulmonary disease (Centers for Disease Control and Prevention, 2008). "
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    • "Furthermore, the association is dosedependent ; increasing exposure to cigarette smoke is associated with earlier onset of symptoms and more severe PAD (Fowler et al 2002; Willgendael et al 2004). Finally, smoking cessation in patients with PAD is associated with a reduction in severity of IC and risk of developing rest pain (Girolami et al 1999), albeit to a lesser degree than the reduction in risk of coronary heart disease and stroke (Willgendael et al 2004). This may drive some of the increasing incidence seen in the elderly. "
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