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Cited by 202Peripheral Artery Disease ManagementSmoking Behavior and CessationChronic Obstructive Pulmonary Disease (COPD) Research

Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease

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Armstrong, Ehrin J., Wu, Julie, Singh, Gagan D., Dawson, David L., Pevec, William C., Amsterdam, Ezra A., Laird, John R.·2014·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2014.08.064
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Abstract

Objective Although smoking cessation is recommended for all patients with peripheral artery disease, there are little data regarding the prevalence of smoking among patients at the time of angiography or the effect of smoking cessation on clinical outcomes.Methods Consecutive patients with claudication or critical limb ischemia who underwent peripheral angiography from 2006 to 2013 were included in an observational cohort analysis. Smoking status was assessed at the time of angiography and during follow-up clinic visits. Kaplan-Meier analysis was used to assess the relationship between smoking cessation, mortality, and amputation-free survival.Results Among 739 patients (423 men and 316 women; mean age, 60 ± 12 years), 204 (28%) remained active smokers at the time of lower extremity angiography. At the time of angiography, the mean number of cigarettes smoked per day was 16 ± 10, and the mean pack-years was 40 ± 25. During the course of the subsequent year, 61 patients (30%) successfully quit smoking and maintained continued abstinence. Baseline medication use between groups did not differ significantly. The mean ankle-brachial index was also similar for quitters vs nonquitters (0.53 ± 24 vs 0.49 ± 0.22; P = .3). During follow-up to 5 years, patients who quit smoking had significantly lower all-cause mortality (14% vs 31%; hazard ratio, 0.40; 95% confidence interval, 0.18-0.90) and improved amputation-free survival (81% vs 60%; hazard ratio, 0.43, 95% confidence interval, 0.22-0.86) compared with patients who continued smoking, with most of the difference driven by reduced mortality among patients who quit smoking. The findings remained significant on multivariable analysis.Conclusions Approximately one-third of active smokers with peripheral artery disease successfully quit smoking ≤ 1 year after lower extremity angiography. Patients who quit smoking have lower mortality and improved amputation-free survival compared with patients who continue smoking.

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  • Individuals who continue smoking experience increased mortality and higher amputation rates.

    “Those individuals who continue smoking experience increased mortality and higher amputation rates.63”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [63]

    Table IV (CONCLUSIONS; page unavailable) reports higher five-year mortality among patients with peripheral artery disease who continued smoking (31% versus 14% among quitters) and a higher observed major-amputation rate (22% versus 7%). The DISCUSSION cautions that a larger study would likely be needed to detect a significant difference in major amputations. The claim omits both that uncertainty and the study’s patient population. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. [13]13. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor par- tial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA 2006;296:47-55.

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Authors
Armstrong, E. J., Wu, J., Singh, G. D., Dawson, D. L., Pevec, W. C., Amsterdam, E. A., & Laird, J. R.
Affiliations
  • University of Colorado Anschutz (US)
  • University of California Davis Medical Center (US)
Corresponding author
Laird, John R.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2014-12
Volume
60
Issue
6
Pages
1565-1571
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2014.08.064
OpenAlex
W2139176490
Cited by
202
References
25
Citations by year
2026: 15 · 2025: 16 · 2024: 18 · 2023: 24 · 2022: 16 · 2021: 24 · 2020: 19 · 2019: 22 · 2018: 15 · 2017: 15 · 2016: 12 · 2015: 5 · 2014: 1
FWCI
10.92
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Keywords
smoking cessation, peripheral arterial disease, critical limb ischemia, intermittent claudication, mortality, amputation-free survival, smoking prevalence, lower extremity angiography, ankle-brachial index, smoking abstinence
MeSH terms
Smoking Prevention, Aged, Amputation, Surgical, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Smoking, Time Factors, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Smoking Cessation, Treatment Outcome, Disease-Free Survival, Limb Salvage, Risk Reduction Behavior, Kaplan-Meier Estimate, Peripheral Arterial Disease

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