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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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- The health consequences of smoking.in: Cardiovascular disease. A report of the Surgeon General. U.S. Department of Health and Human Services, Rockville, Maryland1983: 179-201
- Fate of the patient with chronic leg ischaemia.J Cardiovasc Surg. 1989; 30: 50-57
- Historical perspectives and the Basle study.in: Fowkes FGR Epidemiology of peripheral vascular disease. Springer-Verlag, London1991: 69-83
- Lower extremity arterial disease and the aging process: a review.J Clin Epidemiol. 1992; 45: 529-542
- Fate in intermittent claudication: outcome and risk factors.Br Med J. 1986; 293: 1137-1140
- Update on some epidemiological features of intermittent claudication. The Framingham study.J Am Geriatr Soc. 1985; 33: 13-18
- Metabolic and cardiovascular abnormalities in patients with peripheral arterial disease.Am Heart J. 1975; 90: 703-708
- Risk factors of peripheral arterial occlusive disease: a case-control study in Greece.Int J Epidemiol. 1989; 18: 614-618
- The Framingham study. Cigarettes and the development of intermittent claudication.Geriatrics. 1973; 28: 61-68
- The analysis of case-control studies.in: Statistical methods in cancer research. vol 1. International Agency for Research on Cancer, Lyon, France1980: 123-159
- The analysis of binary data.Methuen, London1970
- Case-control studies: design conduct and analysis.in: Oxford University Press, New York1982: 43-45
☆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.
© 1993 Published by Elsevier Inc.