Combined effects of smoking and peripheral arterial disease on all-cause and cardiovascular disease mortality in a Chinese male cohort.
OBJECTIVE
Smoking is a major risk factor for peripheral arterial disease (PAD), and PAD is associated with all-cause and cardiovascular disease (CVD) mortality. The objective of this study was to determine the combined effects of smoking and PAD on all-cause and CVD mortality.


METHODS
A total of 1979 males 35 years of age or older were enrolled from eight university-affiliated hospitals in Beijing and Shanghai in 2004, with both smoking status and PAD diagnosis obtained, 1712 of them had complete follow-up data. Mortality data were obtained from all participants between December 2007 and February 2008. Cox proportional hazards models were used to evaluate relative risks (RRs) of all-cause mortality and CVD mortality among different groups.


RESULTS
At baseline, the average age of participants was 66.98-years-old (SD = 11.57), prevalence of PAD was 24.0% and 65.4% smoked cigarettes. During the 3-year follow-up, all-cause cumulative mortality rates were 27.9% (PAD/smoker), 26.3% (PAD/nonsmoker), 14.1% (no PAD/smoker), and 14.4% (no PAD/nonsmoker) (P < .001), and CVD cumulative mortality rates were 17.8%, 14.9%, 8.1%, and 7.3%, respectively (P < .001). Compared with the no PAD/nonsmoker subjects, adjusted RR from all-cause mortality in the groups of both PAD/smoker, PAD/nonsmoker, and no PAD/smoker were 1.88 (95% confidence interval [CI], 1.34-2.64), 1.37 (95% CI, 0.85-2.23), and 1.08 (95% CI, 0.79-1.49), respectively. The adjusted RR from CVD mortality was 2.12 (95% CI, 1.37-3.28), 1.55 (95% CI, 0.84-2.86), and 1.13 (95% CI, 0.74-1.71), respectively.


CONCLUSIONS
PAD is a major determinant of mortality. Smoking did not contribute to mortality in this study. Further research is needed.
Luo
Yingyi
Y
Shanghai Institute of Health Sciences, Shanghai, China.
Li
Xiankai
X
Li
Jue
J
Wang
Xiaoming
X
Qiao
Yongxia
Y
Hu
Dayi
D
Merriam
Philip A
PA
Ma
Yunsheng
Y
D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology* / Q000401:mortality*; D002681:China; D015331:Cohort Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000208:ethnology / Q000401:mortality*; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000208:ethnology / Q000401:mortality*; D013997:Time Factors