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 In so-called “peripheral artery disease,” blood from the heart can’t
reach the legs because the arteries are clogged. The result can be
painful cramps while walking or climbing stairs, leg numbness or
weakness, coldness in the lower leg or foot – and in the worst
cases, amputation.
The authors of the new study expected that people with peripheral
artery disease, or PAD, who stopped smoking would do better in the
long run – but they didn’t expect the benefit to be as large as it
was.
PAD patients who continued to smoke were more than twice as likely
to die within five years as those who quit within the year, the
study found.
Patients with the most extreme condition, called “critical leg
ischemia,” who kept smoking were nearly three times as likely to die
within five years compared to their counterparts who gave up
cigarettes, senior author Dr. John Laird told Reuters Health.
Laird, a cardiologist, is the medical director of the University of
California, Davis, Vascular Center.
He expected quitters to live longer than smokers, he said, but did
not imagine the difference in survival times would be so dramatic.
“Common sense told us we would expect some worse outcomes in
smokers. But we were surprised by the magnitude of the difference,”
Laird said.
He said he has been using the mortality data as well as the findings
on amputations to provide further proof to his patients of the value
of quitting smoking.
“No matter how far you are along in the disease, it helps to quit
smoking,” Laird said. “It gives us more fuel when we’re talking with
our patients.”
His research team examined 739 patients with PAD and critical leg
ischemia between 2006 and 2012. Of those, 204 were smokers, and 61
quit successfully within a year.
The risk of dying within five years for the quitters with PAD was 14
percent, compared to 31 percent for those who continued to smoke,
the study found.
For patients with critical leg ischemia, the benefit of smoking
cessation reduced the risk of dying even more substantially – from a
43 percent mortality rate within five years for smokers to an 18
percent rate for quitters, Laird said.
“The outcome (of critical leg ischemia) is really poor if you
continue to smoke,” he said. “Almost half of the patients will be
dead within five years. It’s a terminal illness in some ways.”
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Smoking increases the risk of developing PAD two to six times,
according to the U.S. Centers for Disease Control and Prevention
(CDC). The CDC estimates that PAD afflicts 8 million Americans,
including up to one in five people age 60 and older.
Prior research established the link between smoking and PAD, and
doctors treating PAD patients urge those who smoke to quit, Laird
said. Until now, though, physicians lacked evidence of the benefits
of giving up smoking after being diagnosed with PAD.
“These patients who were able to quit smoking had a dramatically
better outcome,” Laird said. “You’d think that would be the case,
but it hasn’t been proven that stopping smoking really makes a big
impact.”
“But it really does,” he said.
Dr. Christopher Abularrage called the findings “striking” and
described the study as a “great tool” he planned to use to help
persuade his patients to stop smoking. He is a vascular surgeon at
Johns Hopkins Hospital in Baltimore, Maryland, and was not involved
in the current study.
“The point is even if you quit now you can reduce your risk of
dying,” he told Reuters Health.
“Some people will say, ‘I’ve been smoking all this time. Why quit
now?’ This shows that even if they’re able to quit now, despite all
these years of smoking, there’s still an improvement,” Abularrage
said.
“The difference between the two groups is very clear,” he said.
“It’s definitely something I’m going to use in my practice.”
SOURCE: http://bit.ly/10pVlft Journal of Vascular Surgery, online
October 1, 2014.
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