Combined effects of smoking and peripheral arterial disease on all-cause and cardiovascular disease mortality in a Chinese male cohort

Objective: Smoking is a major risk factor for peripheral arterial disease (PAD), and PAD is associated with all-cause and cardiovascular disease (CVD) mortality. The objective of this Study was to determine the combined effects of smoking and PAD on all-cause and CVD mortality. Methods: A total of 1979 males 35 years of age or older were enrolled from eight university-affiliated hospitals in Beijing and Shanghai in 2004, with both smoking status and PAD diagnosis obtained, 1712 of them had complete follow-up data. Mortality data were obtained from all participants between December 2007 and February 2008. Cox proportional hazards models were used to evaluate relative risks (RRs) of all-cause mortality and CVD mortality among different groups. Results: At baseline, the average age of participants was 66.98-years-old (SD = 11.57), prevalence of PAD was 24.0% and 65.4% smoked cigarettes. During the 3-year follow-up, all-cause Cumulative mortality rates were 27.9% (PAD/smoker), 26.3% (PAD/nonsmoker), 14.1% (no PAD/smoker), and 14.4% (no PAD/nonsmoker) (P < .001), and CVD cumulative mortality rates were 17.8%, 14.9%, 8.1%, and 7.3%, respectively (P < .001). Compared with the no PAD/nonsmoker subjects, adjusted RR from all-cause mortality in the groups of both PAD/smoker, PAD/nonsmoker, and no PAD/ smoker were 1.88 (95% confidence interval [CI], 1.34-2.64), 1.37 (95% CI, 0.85-2.23), and 1.08 (95% CI, 0.79-1.49), respectively. The adjusted RR from CVD mortality was 2.12 (95% CI, 1.37-3.28), 1.55 (95% CI, 0.84-2.86), and 1.13 (95% CI, 0.74-1.71), respectively. Conclusion: PAD is a major determinant of mortality. Smoking did not contribute to mortality ill this Study. Further research is needed. (J Vasc Surg 2010;51:673-8.)