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Feb 07, 2019

Study Finds Smoking Increases Risk for Peripheral Artery Disease in Blacks

Smoking cigarettes is strongly linked to reduced blood flow in the limbs, shows study of more than 5,300 black adults.

Cigarette smoking could explain some of the high rates of peripheral artery disease in blacks, based on a recent study that explored the association between smoking and risk for peripheral artery disease in Mississippi adults.

Published in the Journal of the American Heart Association, this study analyzed data from more than 5,300 people in the Jackson Heart Study. The goal was to confirm the association between smoking and increased risk for peripheral artery disease in blacks—a population that is underrepresented in research. Authors also hoped to estimate just how much smoking increased risk for this chronic disease, since blacks are three times more likely to develop peripheral artery disease compared to whites.

Peripheral artery disease, often referred to as PAD, occurs when narrowed arteries reduce blood flow to the limbs, causing symptoms like leg pain and weakness. PAD increases risk for stroke and heart attack and can cause dangerous sores or wounds in the limbs.

In total, the recent analysis included 5,306 black adults from Jackson, MS, whose health was routinely tracked between 2000 and 2008. At the start of the study, participants completed questionnaires about smoking and their overall health and lifestyle. Based on results, 68% of participants had never smoked, 19% were past smokers and 13% were current smokers.

Participants also underwent two key tests to assess signs of peripheral artery disease. The first test measured ankle-brachial index, which compares blood flow in the ankle with blood flow in the arm. The second included CT (computed tomography) scans of large arteries that supply blood to the lower parts of the body to check for any narrowing or calcification. A low ankle-brachial index and/or calcification are both signs of peripheral artery disease and indicate poor blood flow to the lower limbs.

After analysis, researchers found that current smokers were more than twice as likely to have a low ankle-brachial index and 8–9 times more likely to have calcification in their arteries than never smokers. Researchers also found that among smokers, those smoking more than a pack a day were more likely to have signs of peripheral artery disease than those who smoked less.

What findings show, according to authors, is that smoking significantly increases risk for peripheral artery disease in blacks.

While none of the study participants had been diagnosed with PAD at the start of the study, exams showed that many had underlying signs of reduced blood flow to the limbs. Analysis suggests that the more participants smoked, the greater their risk was for underlying PAD.

Since blacks face increased risk for PAD, authors note that prevention and screening are key. Risk factors for PAD are similar to those for heart disease and include smoking, diabetes, obesity, high blood pressure, high cholesterol, age and family history. By addressing these risk factors, most of which we can control, adults can help significantly reduce their risk for developing PAD.

Questions for You to Consider

  • What are the warning signs of PAD?

  • The first inkling that you have PAD is often a painful cramp in the calf or thigh that occurs repeatedly when you walk, but disappears when you’re at rest.  This symptom is known as intermittent claudication.  People with PAD often curtail their activity to avoid further pain. However, inactivity only worsens the condition, creating a downward spiral.

    As PAD becomes more advanced, other symptoms may develop including:

    • Aching or burning in your feet and toes, especially when lying down at night
    • Redness or other color changes to the skin on your feet
    • Skin on the feet that feels cool to the touch
    • Sores on your toes or feet that do not heal
  • How is PAD diagnosed?
  • Doctors often diagnose PAD by using the ankle-brachial index (ABI) to assess blood flow to the legs. The ABI is a simple test that can be done in your doctor’s office. During the test, you lie flat while your doctor measures the blood pressure in both arms using a standard blood pressure cuff and a small hand-held Doppler ultrasound probe. The ultrasound probe detects the first sound of blood flow as the cuff is deflated; that’s the upper number in your blood pressure. Your doctor then measures the blood pressure in both ankles by placing an inflatable blood pressure cuff between the ankle and calf and again using the Doppler ultrasound probe to listen for blood flow.

    The next step is to calculate the ratio of the highest ankle pressure to the highest arm pressure on the same side of the body. This is the ankle-brachial index. If the blood pressure in the ankle is a lot lower than in the arm, it is a sign that a blockage is interfering with blood flow to the lower leg.

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