The association between smoking and the prevalence of intermittent claudication

Abstract

The objective of this study was to investigate the association between smoking and the prevalence of intermittent claudication (IC). Between 1995 and 1997, all residents aged 20 years or older in Nord-Trøndelag County, Norway, were invited to take part in the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag: HUNT 2). A total of 19 748 participants aged 40-69 years attended. Responses to 12 questions on IC (including a Norwegian translation of the Edinburgh Claudication Questionnaire) had been previously tested against the ankle-brachial pressure index (ABPI < 0.9), and an algorithm of the best test properties was used to identify people with IC. Using logistic regression analysis we computed age-adjusted prevalence odds ratios (OR) for the association between smoking and IC. Both current (ORmen = 3.8, confidence interval (CI) 2.1-6.7, ORwomen = 2.2, CI 1.4-3.4) and former smokers (ORmen = 1.7, CI 0.9-3.2, ORwomen = 1.7, CI 1.1-2.7) had a higher prevalence of IC compared with those who had never smoked, and individuals who had stopped smoking more than 20 years previously had a substantially lower prevalence of IC (ORmen = 0.2, CI 0.1-0.5, ORwomen = 0.4, CI 0.2-0.8) than current smokers. We found no association between passive smoking and IC in either men or women. Current and previous smoking habits were positively associated with the prevalence of IC, and smoking cessation was negatively associated in men and women. Passive smoking was not associated with IC in this study.

Meta-analysis of the association between cigarette smoking and peripheral arterial disease

“…Forty-three (78.2%) were cross-sectional studies,22–26 28–31 33 34 36 40–45 47–50 52–55 57–71 74 75 10 (18.2%) were cohort studies21 27 32 38 39 46 51 56 72 73 and 2 (3.6%) were case-control studies 35 37. Forty-seven (84.5%) studies defined PAD using the ABI,21–26 29–34 36–38 40–49 52–55 57–71 73–75 and 7 (12.7%) based on symptoms of intermittent claudication, using either the Edinburgh, WHO/Rose or San Diego claudication questionnaires 28 35 39 50 51 56 72. One study (1.8%) used both the ABI and a claudication questionnaire, and examined symptomatic and asymptomatic PAD separately 27…”

Add-on rosiglitazone therapy improves plasminogen activity and high-density lipoprotein cholesterol in type 2 diabetes mellitus

“…Those who smoke tend to have worse clinical peripheral artery disease and associated intermittent claudication. One reason for this is that there is poor collateral vessel formation, leading to symptoms which are generally worse than those in patients who do not smoke [48,49]. Studies have also shown that patients who smoke have a blunted effect of antihypertensive medication on arterial vasodilatation [50].…”

The association between diabetes mellitus and the prevalence of intermittent claudication: the HUNT study

“…19,20 Further, diabetes was substantially more strongly associated with IC compared to similar associations with smoking and blood lipids in the same population during the same time period. 7,21 Type 2 DM is the most common form of diabetes. In younger patients, however, there will be a relatively larger proportion with type 1 DM.…”

“…4,5 There is an increased incidence and prevalence of DM in almost all age groups in the western world; however, especially in the young. 6,7 Further, the duration of DM is associated with the development of PAD. 8,9 It is therefore likely that the number of patients in the population who suffer from vascular diseases will increase due to a higher prevalence of DM in the general population.…”