title: Smoking, smoking cessation, [corrected] and risk for symptomatic peripheral artery disease in women: a cohort study.
abstract: BACKGROUND
  Smoking has a well-documented detrimental effect on risk for myocardial infarction and stroke, but less information is available regarding peripheral artery disease (PAD), particularly among women.
  
  
  OBJECTIVE
  To prospectively assess the association of current smoking status, cumulative smoking exposure, and smoking cessation with incident symptomatic PAD in women.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  U.S. female health care professionals in the Women's Health Study.
  
  
  METHODS
  39,825 women with no cardiovascular disease who were prospectively followed for a median of 12.7 years.
  
  
  METHODS
  Incidence of symptomatic PAD. Cox proportional hazards models were used to compare PAD risk across smoking categories.
  
  
  RESULTS
  178 confirmed PAD events occurred. Across the 4 smoking categories (never, former, <15 cigarettes/d, and ≥15 cigarettes/d), age-adjusted incidence rates were 0.12, 0.34, 0.95, and 1.63 per 1000 person-years of follow-up, respectively. Multivariate adjustment had little effect on this relationship (adjusted hazard ratios [HRs], 3.14 [95% CI, 2.01 to 4.90], 8.93 [CI, 5.02 to 15.89], and 16.95 [CI, 10.77 to 26.67], respectively, vs. women who never smoked). Additional adjustment for high-sensitivity C-reactive protein and soluble intercellular adhesion molecule-1 levels among women with available blood samples (28,314 participants, 117 events) attenuated risk estimates (HR, 5.58 [CI, 2.61 to 11.93] for smoking <15 cigarettes/d and 9.52 [CI, 5.17 to 17.53] for smoking ≥15 cigarettes/d). Lifetime exposure showed a strong dose-response relationship; fully adjusted HRs for smoking abstinence of fewer than 10, 10 to 29, and 30 or more pack-years were 2.52 (CI, 1.49 to 4.25), 6.75 (CI, 4.33 to 10.52), and 11.09 (CI, 6.94 to 17.72), respectively. Compared with current smokers, the adjusted HRs for fewer than 10 years, 10 to 20 years, more than 20 years, or lifelong abstinence were 0.39 (CI, 0.24 to 0.66), 0.28 (CI, 0.17 to 0.46), 0.16 (CI, 0.10 to 0.26), and 0.08 (CI, 0.05 to 0.12), respectively.
  
  
  CONCLUSIONS
  The use of symptomatic PAD as the a priori primary end point excludes asymptomatic disease.
  
  
  CONCLUSIONS
  Among initially healthy women, smoking is a potent risk factor for symptomatic PAD and was associated with subclinical inflammation. Smoking cessation substantially reduces risk for PAD, but an increased occurrence of PAD persists even among former smokers who maintain abstinence.
  
  
  BACKGROUND
  The National Heart, Lung, and Blood Institute and National Cancer Institute.
authors.affiliation: University Hospital, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Conen
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Everett
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.forename: Mark A
authors.initials: MA
authors.lastname: Creager
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.forename: Aruna D
authors.initials: AD
authors.lastname: Pradhan
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D013997:Time Factors
chemical_list: D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein