Data Show Benefits of Smoking Cessation for Symptomatic PAD Patients

December 1, 2014—A study published by Ehrin J. Armstrong, MD, et al in the Journal of Vascular Surgery found that approximately one-third of active smokers with peripheral artery disease (PAD) successfully quit smoking ≤ 1 year after lower extremity angiography and that those patients who quit smoking have lower mortality and improved amputation-free survival compared with patients who continue smoking (2014;60:1565–1571).

As outlined in the background of the study, although smoking cessation is recommended for all patients with PAD, there are little data regarding the prevalence of smoking among patients at the time of angiography or the effect of smoking cessation on clinical outcomes.

This observational cohort analysis included consecutive patients with claudication or critical limb ischemia who underwent peripheral angiography from 2006 to 2013. Smoking status was assessed at the time of angiography and during follow-up clinic visits. Kaplan-Meier analysis was used to assess the relationship between smoking cessation, mortality, and amputation-free survival.

Among 739 patients (423 men and 316 women; mean age, 60 ± 12 years), 204 (28%) remained active smokers at the time of lower extremity angiography. At the time of angiography, the mean number of cigarettes smoked per day was 16 ± 10, and the mean pack years was 40 ± 25. During the course of the subsequent year, 61 patients (30%) successfully quit smoking and maintained continued abstinence. Baseline medication use between groups did not differ significantly. The mean ankle-brachial index was also similar for quitters versus nonquitters (0.53 ± 24 vs 0.49 ± 0.22; P = .3).

The investigators reported that during follow-up to 5 years, patients who quit smoking had significantly lower all-cause mortality (14% vs 31%; hazard ratio, 0.4; 95% confidence interval, 0.18–0.9) and improved amputation-free survival (81% vs 60%; hazard ratio, 0.43, 95% confidence interval, 0.22­­–0.86) compared with patients who continued smoking, with most of the difference driven by reduced mortality among patients who quit smoking.

The findings remained significant on multivariable analysis, stated the investigators in the Journal of Vascular Surgery.