Article

Influence of smoking on incidence and prevalence of peripheral arterial disease.

Department of Surgery, Division of Vascular Surgery, Atrium Medical Center, Heerlen, The Netherlands.
Journal of Vascular Surgery (Impact Factor: 2.98). 01/2005; 40(6):1158-65. DOI: 10.1016/j.jvs.2004.08.049
Source: PubMed

ABSTRACT 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.

0 Bookmarks
 · 
92 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Underlying vascular disease is an important pathophysiologic factor shared among many co-morbid conditions associated with poor fracture healing, such as diabetes, obesity, and age. Determining the temporal and spatial patterns of revascularization following fracture is essential for devising therapeutic strategies to augment this critical reparative process. Seminal studies conducted in the last century have investigated the pattern of vascularity in bone following fracture. The consensus model culminating from these classical studies depicts a combination of angiogenesis emanating from both the intact intramedullary and periosteal vasculature. Subsequent to the plethora of experimental fracture angiography in the early to mid-20th century there has been a paucity of reports describing the pattern of revascularization of a healing fracture. Consequently the classical model of revascularization of a displaced fracture has remained largely unchanged. Here, we have overcome the limitations of animal fracture models performed in the above described classical studies by combining novel techniques of bone angiography and a reproducible murine femur fracture model to demonstrate for the first time the complete temporal and spatial pattern of revascularization in a displaced/stabilized fracture. These studies were designed specifically to i) validate the classical model of fracture revascularization of a displaced/stabilized fracture ii) assess the association between intramedullary and periosteal angiogenesis and iii) elucidate the expression of VEGF/VEGF-R in relation to the classical model. From the studies, in conjunction with classic studies of angiogenesis during fracture repair, we propose a novel model (see abstract graphic) that defines the process of bone revascularization subsequent to injury to guide future approaches to enhance fracture healing. This new model validates and advances the classical model by providing evidence that during the process of revascularization of a displaced fracture 1) periosteal angiogenesis occurs in direct communication with the remaining intact intramedullary vasculature as a result of a vascular shunt and 2) vascular union occurs through an intricate interplay between intramembranous and endochondral VEGF/VEGF-R mediated angiogenesis.
    Bone 10/2014; · 4.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Risk factors for development of extremity artery atherosclerosis are the same as for coronary and cerebrovascular atherosclerosis namely, diabetes mellitus, hyperlipidemia, arterial hypertension, age and smoking. Atherosclerosis is polyarterial disease that clinically manifests itself most frequently in the form coronary, cerebrovascular or peripheral arterial disease (PAD). All of them have common, ominous and final pathologic step - atherosclerotic plaque rupture that might eventually lead to atherothrombosis and signs of ischemia. There are few studies of risk factor for peripheral artery disease (PAD). To identify prevalence of known risk factors for atherosclerosis in patients treated for acute atherothrombosis of extremity arteries. Eighty patient were analyzed with regard to the prevalence of five risk factors for atherosclerosis (diabetes mellitus, smoking, hypertension, hyperlipidemia and age). 80 patients were divided into two groups (Group A and B) depending on country i.e. hospital where they received treatment for acute atherothrombosis of extremity artery. Group A consisted of patients treated at Clinic for vascular surgery in Sarajevo, while patients in Group B were treated in Trollhattan in Sweden at NAL hospital. This study was clinical, comparative, retrospective-prospective. In group A, 20% of patients had diabetes mellitus while in group B prevalence of diabetics was lower (12,5%) but difference was not statistically significant p>0.05. Sixty percent of patients (60%) in group A were smokers. In Sweden, habit of smoking is not as common as in Balkan countries and consequently only 22,5% of patients were smokers in Group l, difference was statistically significant, p<0.05. In patients assigned to group A, 42.5% of them had diagnosis of hypertension while in Group B, 35% of patients were hypertensive. Difference was not statistically significant, p>0.05. 37.5% of patients in group A and 20% of patients in group B had hyperlipidemia. Difference was not statistically significant, p>0.05. In Group A mean age of patients was 67.85 years while mean age in Group B was 73.63. Age difference was statistically significant, p<0.05. Prevalence of risk factors of atherosclerosis in peripheral artery disease were evaluated in this study. Significant difference in prevalence of two risk factors were determined namely, smoking and mean age of occurrence of atherothrombosis. Quiting smoking and adopting healthier life habits may lead to reduction of prevalence PAD in younger patients in Bosnia and Herzegovina.
    Medical Archives 10/2014; 68(5):329-31.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This abstract describes the operation of an automated electrochemical cell that utilizes an ion selective electrode (ISE) as the detector. The instrument can rapidly and automatically generate on-line estimates of the concentration of an ion, thus providing chemical information useful for controlling a chemical process. A typical application might be the monitoring of a sewage treatment plant to facilitate control of the concentration of a contaminant in discharged water.
    Decision and Control including the 16th Symposium on Adaptive Processes and A Special Symposium on Fuzzy Set Theory and Applications, 1977 IEEE Conference on; 01/1977

Full-text

Download
73 Downloads
Available from
May 29, 2014