title: Self-reported history of childhood smoking is associated with an increased risk for peripheral arterial disease independent of lifetime smoking burden.
abstract: Atherosclerotic disorders are well known to be associated with obesity, lipid profile, smoking, hypertension and other medical comorbidities, and large cohort studies have explored the childhood correlates to these adult risk factors. However, there has been little investigation into the childhood risk factors for peripheral arterial disease (PAD). We endeavored to better understand the role of smoking in childhood in the risk for PAD in a well described cohort of 1,537 adults at high risk for cardiovascular disease. In a multivariate regression model, we observed an increased risk of PAD among those who reported a history of smoking during childhood (OR = 2.86; 95% CI, 1.99-4.11; P<0.001), which remained statistically significant after controlling for lifetime smoking burden (OR = 1.55; 95% CI, 1.00-2.41; P = 0.049). Our novel observation of disproportionate risk of PAD conferred by a history of childhood smoking may reflect an unrecognized biological mechanism such as a unique susceptibility to vascular injury or an unaccounted for covariate such as secondhand smoke exposure in childhood. This observation suggests further investigation is required into the pathophysiology of smoking in the developing vasculature and the need for detailed clinical data about patterns of childhood smoking and smoke exposure.
authors.affiliation: Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, United States of America ; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: James R
authors.initials: JR
authors.lastname: Priest
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Nead
authors.affiliation: Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Mackenzie R
authors.initials: MR
authors.lastname: Wehner
authors.affiliation: Center for Cardiovascular Regeneration, Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States of America ; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: John P
authors.initials: JP
authors.lastname: Cooke
authors.affiliation: Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America ; Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Leeper
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001835:Body Weight; D002140:California / Q000453:epidemiology; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D006801:Humans; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000453:epidemiology* / Q000209:etiology*; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D008076:Cholesterol, HDL; D003404:Creatinine