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Editorial
October 6, 2021

Smoking Cessation Improves Outcomes in Patients With Peripheral Artery Disease

Author Affiliations
  • 1Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
  • 2Department of Medicine, Whitaker Cardiovascular Institute, Boston University School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, Massachusetts
JAMA Cardiol. 2022;7(1):15-16. doi:10.1001/jamacardio.2021.3987

Peripheral artery disease (PAD), defined as atherosclerotic obstruction of the arteries supplying the limbs, affects approximately 8.5 million adults living in the US and more than 235 million people worldwide.1,2 Patients with PAD have functional limitations related to impaired walking capacity and intermittent claudication, and those most severely affected are at risk of limb loss. Cigarette smoking increases the odds of having PAD by 2-fold to 4-fold, more so than for coronary artery disease, and its attributable risk for PAD exceeds 40%. Cigarette smoking may contribute to the development, progression, and adverse outcomes of PAD via its effects on oxidative stress and inflammation and by adversely affecting endothelial and platelet function, lipoprotein metabolism, and coagulation pathways. Tobacco use in patients with PAD is associated with substantial increases in health care utilization, including PAD-related hospitalizations and procedures for both coronary artery disease and PAD, and significantly greater costs.3 Active smoking increases the risk of graft failure following limb bypass surgery, delays wound healing following endovascular intervention in patients with critical limb ischemia, and increases the risk of amputation in patients with symptomatic PAD.

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