Risk factor profile of nonsmokers with peripheral arterial disease

Cigarette smoking is a very common and important risk factor for peripheral arterial disease (PAD) such that a history of never having smoked is unusual in diseased subjects. The aim of this study was to determine whether never smokers with PAD had a unique risk factor profile that put them at particularly high risk of disease. The study population was derived from the Edinburgh Artery Study, which is a cross-sectional random sample survey of 1592 men and women aged fifty-five to seventy-four years. PAD was measured by means of the WHO questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test. Cigarette smoking was measured by use of a standardized questionnaire. In the 561 subjects who had never smoked, 32 (5.7%) had PAD as compared with 12.3% in ex-smokers and 17.8% in current smokers. The never smokers with disease were slightly older and were more likely to be female than the current smokers. They had a higher body mass index, serum cholesterol (non-HDL), HDL cholesterol, systolic and diastolic blood pressure, and glucose intolerance, although a statistically significant difference (P < 0.01) between never and current smokers was found only for body mass index. The risks of disease associated with each risk factor were not significantly different. The authors conclude that a unique risk factor profile for disease was not apparent among subjects who had never smoked, although never smokers were more likely to be women and to have higher levels of other risk factors.