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Evidence summaries

Smoking Cessation as Treatment for Intermittent Claudication

Smoking cessation may reduce rest pain, myocardial infarction, and cardiac death in patients with intermittent claudication. Level of evidence: "C"

Summary

A meta-analysis 1 of the association between cigarette smoking and peripheral arterial disease (PAD) included 55 studies (43 cross-sectional, 10 cohort and 2 case-control). Current smoking was associated with PAD (OR 2.71, 95% CI 2.28 to 3.21). The association was observed among both general (OR 3.08, 95% CI 2.56 to 3.69) and disease populations (OR 1.54, 95% CI 1.31 to 1.83). The magnitude of the association was greater than that reported for coronary heart disease.

A cohort study 2 on the effects of smoking cessation included 343 subjects with intermittent claudication. One year after the initial examination 39 (11%) had stopped smoking and 304 (89%) continued to smoke. Rest pain developed in 0% of non-smokers vs. 16% of smokers after 7 years (p<0.05). The cumulative proportions with myocardial infarction were 11% and 53%, and cardiac death 6% and 43% after 10 years; and the 10-year survival was 82% and 46% among non-smokers and smokers, respectively. In multivariate Cox regression analyses the association between smoking and infarction (p<0.05) and cardiac death (p<0.05) was significant.

A systematic review 3 including 4 studies with a total of 183 patients in the intervention group and 683 in the control group was abstracted in DARE. Smoking cessation resulted in an increase of 46.7 m in total walking distance (95% CI -19.3 m to 112.7 m).

    References

    • Lu L, Mackay DF, Pell JP. Meta-analysis of the association between cigarette smoking and peripheral arterial disease. Heart 2014;100(5):414-23. [PubMed]
    • Jonason T, Bergström R. Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality. Acta Med Scand 1987;221(3):253-60. [PubMed]
    • Girolami B, Bernardi E, Prins MH, Ten Cate JW, Hettiarachchi R, Prandoni P, Girolami A, Büller HR. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl: a meta-analysis. Arch Intern Med 1999 Feb 22;159(4):337-45. [PubMed][DARE]

Primary/Secondary Keywords