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Women, Smoking, and PAD Risk


Smoking, even short-term or occasional, increases a woman’s risk of developing PAD (peripheral artery disease). This risk is increased by more than 10-fold in women who smoke ≥15 cigarettes/d according to new research published today in the Annals of Internal Medicine.

Peripheral artery disease (PAD) is a narrowing of the peripheral arteries, especially in the legs. PAD is similar to coronary artery disease (CAD) and often a person will have both diseases. Smoking, diabetes, hypertension, and high cholesterol increase the risk of PAD.

According to the American Heart Association, 8 million Americans are affected by PAD. Symptoms include pain in the legs or a feeling of tiredness in the leg muscles while walking that may get better or go away if the person rests.

Eruna Pradhan, Assistant Professor of Medicine at Harvard Medical School and team conducted a prospective cohort study involving 38,825 women aged at least 45 years who were followed for an average of 12.7 years.

The research objective was to assess the association smoking (past or present) with the incident of symptomatic PAD in women.

The participants filled out a questionnaire, twice during the first year of the study and every year thereafter, regarding their smoking status and history, including how many cigarettes were smoked each day, and details on PAD symptoms and whether they had had a revascularization procedure used to treat PAD. Women who answered “yes” were interviewed by study personnel, and their medical records were reviewed.

The women were placed into 4 smoking categories: never, former,

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The researchers found that smoking is definitely a major risk factor for symptomatic peripheral artery disease. The more cigarettes a woman smoked per day, the more likely she was to develop to PAD. The heaviest smokers had more than a 10-fold increased risk over the never smoked group. Across the 4 smoking categories (never, former,

Lifetime exposure showed a strong dose–response relationship; fully adjusted HRs for smoking abstinence of fewer than 10, 10 to 29, and 30 or more pack-years were 2.52 (CI, 1.49 to 4.25), 6.75 (CI, 4.33 to 10.52), and 11.09 (CI, 6.94 to 17.72), respectively.

Women who stopped smoking were less likely to have PAD than women who continued to smoke. The longer it had been since a woman stopped smoking, the less likely she was to have PAD. However, no matter how long it had been since they quit, women who had ever smoked still had greater risk for PAD than nonsmokers.

Although giving up smoking definitely brings down the risk of developing PAD considerably, it was found never to reach the same low level risk of lifetime non-smoking women.

Pradhan stated, "This study showed that-as has been previously shown for heart attacks and for lung cancer-that smoking is actually very harmful for the development PAD. This is significant because PAD is a disease that not only causes a lot of pain and discomfort with usual, daily activities but it also increases the risk of heart attack."

People with peripheral arterial disease have four to five times more risk of heart attack or stroke.

Smoking, Smoking Status, and Risk for Symptomatic Peripheral Artery Disease in Women: A Cohort Study; David Conen, Brendan M. Everett, Tobias Kurth, Mark A. Creager, Julie E. Buring, Paul M Ridker, and Aruna D. Pradhan; Ann Intern Med June 7, 2011 154:719-726;

Annals of Internal Medicine: Patient Summary: Smoking and Peripheral Artery Disease in Women