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Men Who Smoke at Greater Risk of Peripheral Artery Disease

Smokers and those with hypertension, high cholesterol, and type 2 diabetes face higher risk of Peripheral Artery Disease (PAD).

Engraving of the human heart-- by Jenara Nerenberg

The Gist

Men who smoke, have hypertension, high cholesterol, or type 2 diabetes are likely to face a range of health complications. A new study has shown that peripheral artery disease (PAD) is yet another consequence to worry about. The Harvard Medical School study, published in the October 24/31 issue of JAMA, examined data from 45,000 men in Chicago over 25 years and concluded that as the frequency, severity, and duration of the above risk factors increase, the greater the risk of developing PAD. And PAD, which is blockage of the arteries, raises the risk of heart complications and heart failure.

The study further concludes that risk for PAD doubles each time an additional risk factor is present—that is, if a smoker develops hypertension, his risk for PAD is double what it was when he was just a smoker. Men who did not smoke, have hypertension, high cholesterol, or type 2 diabetes had a 77 percent less chance of developing PAD. Additionally, in 96 percent of those with PAD, one or more of the above risk factors was present when PAD developed.

The Expert Take

“In this well-characterized cohort of U.S. men followed up for longer than 2 decades, smoking, hypertension, hypercholesterolemia, and type 2 diabetes each demonstrated strong, graded, and independent associations with risk of clinically significant PAD,” the authors conclude. The study makes clear that such risk factors contribute to blocked arteries, and that PAD is just one of several unwanted health outcomes putting patients at risk of heart failure and death. 

The Takeaway

Men who smoke, have hypertension, high cholesterol, or type 2 diabetes are at increased risk of developing heart complications and heart failure, and PAD is another heart-related concern to consider. Blocked arteries are known to cause heart attacks and sometimes death. As such, the above four risk factors should be noted with care, and treatment should be sought out to help reduce the risk of heart disease and death. 

"Those four risk factors [smoking, hypertension, high cholesterol, and type 2 diabetes] are independent and multiplicative," said study co-author Kenneth J. Mukamal, M.D., M.P.H. in an interview with Healthline. "Even if you have one of them—say, high blood pressure—it appears important not to get additional ones. Every additional risk factor counts just as much." 

Preventive action such as exercise, eating healthy, and avoiding smoking may also greatly improve health outcomes for at-risk men and prevent the onset of PAD in the first place. "For this type of cardiovascular disease, the risk from smoking persists for as long as we can measure, so it is important not to start," said Mukamal. "Our results may suggest that we needn't worry excessively about undiscovered risk factors or factors like genetics that we don't measure clinically. Preventing the well-known risk factors—hypertension, diabetes, smoking, and high cholesterol—could potentially eliminate as much as 80 percent of this type of vascular disease."

Source and Method

From 1986 to 2011, 44,985 men were followed for this study. The relevant four risk factors were examined in the participants every 5 years in order to keep track of and update the data. The study, called the Health Professionals Follow-up Study, took place in Chicago.

Other Research

A 2002 study from the American Heart Journal examined data from the well-known Framingham Offspring Study and concluded that smoking and hypertension were leading risk factors for PAD, and that efforts to reduce the two would help reduce risk for PAD. The study also noted the role of diabetes and high cholesterol.

And a 2004 study from Johns Hopkins Medical Institutions notes the high prevalence of PAD in African Americans, some of whom are already at increased risk for hypertension and diabetes due to environmental causes.

Those with a condition called renal insufficiency also have higher rates of PAD, notes a 2004 study from San Francisco's VA Medical Center, independent of age, hypertension, diabetes, stroke history, coronary artery disease, and high cholesterol.

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Tags: Awareness , Global Health , Latest Studies & Research , Public Health & Policy

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