Smokers with peripheral artery disease not getting enough help from doctors

By American Heart Association News

Person's hand holding cigarette. (Amie Vanderford for AHA News)
(Amie Vanderford for AHA News)

Doctors are not doing nearly enough to help peripheral artery disease patients quit smoking, a key risk factor for the disease, a new study shows.

The study, published Wednesday in the Journal of the American Heart Association(link opens in new window), took a close look at the relationship between smoking and peripheral artery disease, or PAD, a narrowing of the peripheral arteries serving the legs, arms, head and stomach. More than 202 million people are affected by PAD worldwide, and many of them smoke: More than one-third of PAD patients in the study were active smokers.

"Smoking is the single most important modifiable risk factor for peripheral artery disease. It is associated with faster progression of the disease, greater risk of complications such as limb amputations, heart attacks and death, and also poor response to treatment," said the study's lead author, Dr. Krishna Patel, a cardiology fellow at the University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute.

"Smoking cessation is the cornerstone for managing patients with PAD. It could halt the disease progression and improve and reverse some of these risks," she said.

Researchers studied 1,275 patients at vascular specialty clinics in the United States, Australia and the Netherlands who were in advanced stages of PAD with blockages in limb arteries. The year-long study found that few doctors emphasized smoking cessation or gave patients adequate resources to help them quit, Patel said.

"Less than one in five smokers received a referral to a smoking cessation counseling program from their doctors, and only 1 in 10 received medicines or nicotine replacement therapy to help them quit," she said. "Perhaps as a result, these patients either continue smoking or have a very high rate of relapse if they make an attempt to quit."

Patel said one-third of smokers in the study who tried to quit relapsed within a year. "Doctors taking care of these patients need to be aware of this and should treat smoking as any other chronic addiction problem and provide consistent, repeated and continuous smoking cessation support," she said.

Dr. Aruna Pradhan, a cardiologist and epidemiologist at Brigham and Women's Hospital in Boston, called the study "a call to action to the vascular community."

"This is a unique, well-conducted study that provides a clear message to providers that we're not doing enough about this issue," said Pradhan, who was not involved in the research.

Pradhan said there were several reasons why she and other cardiologists might not have done enough to help PAD patients quit smoking, including a lack of time and not being aware of how effective smoking cessation therapies can be.

"We're guilty of not going out of our comfort zone into areas like nutrition and smoking cessation and lifestyle behavioral modifications," she said. "We're often so focused on pharmacotherapies for things we know we can treat – things like LDL cholesterol and blood pressure."

She said she'd like to see studies on the best ways to get cardiologists to include smoking cessation in PAD treatment, especially because more and more health insurance plans now cover smoking cessation.

Whatever the answer is, the study offers a clear message that cardiologists need to increase their time and effort in this area, Pradhan said.

"Smoking cessation is an intervention that can prevent progression of this disease. We really need to get on board," she said.

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