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Abstract
Background. The importance of cigarette smoking in the etiology of peripheral arterial occlusive
disease is well known, but there have been few studies that have quantified this relationship.
Methods. A case-control study design was used in which the case subjects were men with a history
of claudication for at least 1 year and abnormal findings on noninvasive blood flow
studies or on arteriography; control subjects were men attending the same hospital
for conditions other than cancer, with no history of cancer or vascular disease and
with a normal ankle-brachial index. Case and control subjects were interviewed by
a trained nurse interviewer using a pilot-tested questionnaire. Current smoking status
was confirmed by serum cotinine level estimation. Univariate odds ratios for smoking
and other potential risk factors were calculated, and their significance was tested
by comparison with the chi-squared distribution. Logistic regression analysis was
used to adjust the effect of smoking for confounding variables, and the regression
equation was used to estimate the proportion of disease attributable to smoking.
Results. Of the patients approached, 94% of the eligible case subjects and 93% of the eligible
control subjects agreed to participate. Recruitment ended with 102 cases of peripheral
arterial occlusive disease and 99 controls. Most of the control subjects were attending
clinics for other surgical specialties. Compared with men who had never smoked the
relative risk was 7 for exsmokers and 16 for current smokers (p < 0.001). The relative
risk increased directly with the lifetime number of cigarettes smoked, the chi-squared
test for trend being highly significant (p < 0.001). Age, lipoprotein concentration,
body mass index, and history of hypertension or heart disease were also significant
risk factors.
Conclusions. After adjustment for confounding variables the estimate of the fraction of disease
attributable to smoking was 76%.
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Article info
Footnotes
☆Study supported by the Bureau of Tobacco Control, Health Protection Branch, Health and Welfare Canada.
☆☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
