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(Reuters Health) – African-Americans who smoke cigarettes are more likely than those who don’t smoke to develop peripheral artery disease (PAD), a U.S. study suggests.

Smoking has long been linked to increased risk for PAD, which 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. 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 PAD in their extremities. 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, online January 23.

“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.”

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.”


J Am Heart Assoc 2019.

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