Prevalence of peripheral arterial disease: persistence of excess risk in former smokers

To determine the age-standardised prevalence of peripheral arterial disease (PAD) and associated risk factors, particularly smoking.

Cross-sectional survey of a randomly selected population.

Metropolitan area of Perth, Western Australia.

Men aged between 65-83 years.

The adjusted response traction was 77.2%. Of 4,470 men assessed, 744 were identified as having PAD by the Edinburgh Claudication Questionnaire and/ or the ankle-brachial index of systolic blood pressure, yielding an age-standardised prevalence of PAD of 15.6% (95% confidence intervals (CI): 14.5%: 16.6%). The main risk factors identified in univariate analyses were increasing age, smoking-current (OR = 3.9, 95% CI 2.9-5.1) or former (OR = 2.0, 95% CI 1.6-2.4), physical inactivity (OR = 1.4, 95% CI 1.2-1.7), a history of angina (OR = 2.2, 95% Cl 1.8-2.7) and diabetes mellitus (OR = 2.1, 95% Cl 1.7-2.6). The multivariate analysis showed that the highest relative risk associated with PAD was current smoking of 25 or more cigarettes daily (OR = 7.3, 95% Cl 4.2-12.8). In this population, 32% of PAD was attributable to current smoking and a further 40% was attributable to past smoking by men who did not smoke currently.

This large observational study shows that PAD is relatively common in older, urban Australian men. In contrast with its relationship to coronary disease and stroke, previous smoking appears to have a long legacy of increased risk of PAD.

This research emphasises the importance of smoking as a preventable cause of PAD.