Age at onset of smoking is an independent risk factor in peripheral artery disease development

The potential effects of age at onset of smoking on cardiovascular diseases have been studied little, in contrast to the well-established evidence supporting a causal role of cigarette smoking in these diseases. We sought to analyze the relationship between age at smoking onset and development of symptomatic peripheral arterial occlusive disease (PAOD).

A population-based sample of 573 active or former male smokers aged 55 to 74 years were studied. Present or previous symptomatic PAOD was confirmed by noninvasive testing.

Sixty-one subjects (10.6%) had symptomatic PAOD. Prevalence of disease increased with earlier starting age (15.6% if 16 years) of smoking. After controlling for risk factors that meet confounding factor criteria (ie, subject age and number of pack-years), men who started smoking at age 16 or earlier had a substantially higher risk for development of PAOD (odds ratio, 2.19; 95% CI, 1.15-4.15; P =.016) than men who began to smoke at a later age.

A starting age for smoking of 16 years or earlier more than doubles the risk of future symptomatic PAOD regardless of the amount of exposure to cigarette smoking.