title: Influence of smoking on incidence and prevalence of peripheral arterial disease.
abstract: OBJECTIVE
  Many studies have been published regarding the influence of smoking on the incidence and prevalence of peripheral arterial disease (PAD). A systematic review was performed to establish the magnitude of the effect of smoking on the development of PAD, and a possible dose-response relationship.
  
  
  METHODS
  English-language articles were reviewed by 2 observers using a standardized form, and were summarized in tabular form. Data were extracted by 2 independent observers. Where possible, outcome data, expressed in terms of prevalence or incidence, were recalculated as odds ratio or relative risk, with never-smokers as the reference group, or if this was not available the nonsmoker group. Most studies did not provide primary data. Therefore the weighted means were reported as a summary estimate, provided that a funnel plot between sample size and observed effect size made publication bias unlikely.
  
  
  RESULTS
  Sixteen articles describing 17 studies were included in the analysis. Four of the studies were prospective, and 13 were cross-sectional. The prevalence of symptomatic PAD was increased 2.3-fold in current smokers. Even in former smokers the prevalence was substantially increased by a factor of 2.6. A clear dose-response relationship, with a strong increase in risk for PAD in heavy smokers was observed. In countries where approximately 30% of the population are smokers, 50% of PAD can be attributed to smoking.
  
  
  CONCLUSIONS
  Smoking is a potent risk factor for symptomatic PAD, with an important and consistent dose-response relationship. With the persistence of high risk for PAD in former smokers, tobacco control programs should continue to advocate smoking cessation, but focus even more on preventing future generations from ever starting to smoke.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Edith M
authors.initials: EM
authors.lastname: Willigendael
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Bartelink
authors.forename: Barthold W
authors.initials: BW
authors.lastname: Kuiken
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects*