[Effect of smoking on the incidence of adverse outcomes and ischemic wounds in peripheral artery disease].

Background: Smoking is a major risk factor for peripheral artery disease (PAD), which correlates with progression of the disease, the prevalence of chronic wounds, amputation incidence and mortality. On the other hand, abstinence from smoking has a beneficial effect on the bypass grafts patency after surgical revascularization. Poland fits in the steady decline in the percentage of smokers, but there is a lack of current data, whether those changes are observed also in patients with PAD and whether they lead to the improvement of health condition.

Objective: This study evaluated the impact of smoking and other known risk factors for cardiovascular disease on the occurrence of PAD, the risk of adverse outcomes (death, amputation, tissue necrosis), development of chronic wounds and their healing after arterial revascularization.

Materials and methods: The study was conducted in groups of 208 patients with PAD scheduled for surgical treatment (28.4% of patients with adverse outcomes of PAD, 38.5% of patients with ischemic wounds) and 190 control subjects. The study groups were interviewed concerning smoking, characterized by known risk factors for cardiovascular disease, and in the incidence of amputation, and deaths within 30 days after surgery. In the group of 48 patients with ischemic wounds a prospective assessment of the progress of wound healing in terms of changes in the wound advancement and changes in pain severity associated with wounds was performed.

Results: Over 90% of patients with PAD were smokers: 53.8% former and 36.5% past in relation to 27.4% and 14.7%, respectively, in the control group (p <0.0001). Among patients, a higher proportion of former smokers was found in those with poorer health condition: with adverse outcomes of PAD (48.0% vs 64.1%, p <0.05), and with ischemic wounds (70.7% vs 65.1%, p = 0.056). Advanced age, female sex, and the presence of diabetes were associated with both, the presence of PAD adverse outcomes, as well as the development of ischemic wounds. In the prospective study, major factors prolonging the process of wound healing were advanced age, diabetes and smoking (evaluated as peaks years of smoking).

Conclusions: Smoking is still the most common risk factor for PAD, and smoking cessation is the result of the deterioration of health condition. Simultaneously this factor, in addition to diabetes, advanced age and female sex, affects both the risk of unfavorable course of PAD and decrease the progress of wound healing. Control of risk factors for cardiovascular disease should be especially careful in women in whom, despite the lower PAD incidence, further prognosis of disease progression seem worse.