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 Smoking has long been linked to increased risk for peripheral artery
disease (PAD), which restricts blood flow to the extremities and can
lead to mobility limitations, amputations and heart attacks. Even
though African-Americans are almost three times more likely to
develop PAD than white people in the U.S., research to date hasn't
offered a clear picture of what role smoking plays in the
development of this artery disease in the black community.
For the current study, researchers examined data on 5,306 black men
and women enrolled in the Jackson Heart Study in Mississippi to see
how any current or past smoking might influence their risk of having
early, symptomless indications of PAD in the extremities and in the
aorta, the body's main artery.
At the start of the study, 68 percent of the participants had never
smoked, while 19 percent were former smokers and 13 percent were
current smokers.
Compared to nonsmokers, current smokers were more than twice as
likely to have signs of "subclinical," or symptomless, PAD in their
extremities, such as reduced blood flow in the ankles. Current
smokers were also more than nine times as likely to have
calcification, a sign of subclinical PAD, in their aorta,
researchers report in the Journal of the American Heart Association.
"Among African Americans, cigarette smoking is highly associated
with measures of a PAD, and individuals who smoke more appear to
have worse disease," said lead study author Dr. Donald Clark III of
the University of Mississippi Medical Center in Jackson.
"In addition to the often cited risks of cardiovascular disease and
cancer, in this population there is a clear association with smoking
and PAD," Clark said by email. "These data support efforts
evaluating the impact of interventions on smoking cessation to
reduce PAD in this population."
Peripheral artery disease (PAD) is a narrowing of arteries other
than those directly serving the heart. These blood vessels provide
blood flow to the arms, legs, the brain and other organs such as the
kidneys.
Reduced blood flow from PAD is associated with a risk of stroke,
kidney failure, erectile dysfunction, pain in the legs when walking
and amputations. PAD is also associated with several heart disease
risk factors including high blood pressure, diabetes and obesity.
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In the current study, many participants were overweight or obese,
got limited physical activity and had less than a high school
education.
Current smokers were more likely to use alcohol, and former smokers
were more likely to be older and have other chronic health problems
like high blood pressure and diabetes.
These current smokers had a higher risk of PAD than former smokers,
the study also found.
Among the current smokers, those smoking more than a pack a day, or
about 20 cigarettes, also had a greater risk of PAD than people
smoking less.
The study wasn't designed to prove whether or how smoking might
directly cause PAD, and it also didn't follow participants over time
to see if subclinical symptoms advanced to full-blown PAD.
Still, smoking is the top risk factor for peripheral artery disease
and the study offers fresh evidence of how cigarette use may impact
the risk of PAD among African-Americans who are already at high risk
for developing this condition, said Dr. Joseph Ladapo, a researcher
at the David Geffen School of Medicine at University of California
Los Angeles who wasn't involved in the study.
"The take-home message is that people should do everything within
their power to quit smoking, and if their attempt fails, they should
try again and again and again," Ladapo said by email.
"Symptoms of peripheral artery disease do improve with smoking
cessation, along with cardiac health, and cancer risk," Ladapo
added. "If a smoker doesn't succeed in quitting, the best thing to
do is to try again, and, in the meantime, reducing elevated
cholesterol with statins and controlling other risk factors such as
diabetes and hypertension are helpful."
SOURCE: https://bit.ly/2SwSN9Q Journal of the American Heart
Association, online January 23, 2019.
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