An evaluation of peripheral arterial insufficiency between smokers and non-smokers in Malta.

Abstract

Background: Peripheral arterial disease (PAD) is a common condition effecting the general population. PAD is associated with functional disability, risk of limb loss and is overlooked in primary care settings because most patients are asymptomatic. Although many risk factors are associated with PAD, smoking is considered as the most potent habitual risk factor that is still highly prevalent in the Maltese population.

Aim: To investigate whether daily tobacco smoking has an affect on peripheral artery insufficiency, specifically lower-extremity peripheral arterial disease in a cohort of middleaged healthy individuals. Objectives: To assess the association between smoking status and lower extremity PAD by using easily accessible screening methods such as foot pulse palpation, ankle brachial pressure index (ABPI) and quantitative Doppler waveform analysis. Design & Methods: A non-experimental quantitative study was employed to evaluate the effects of smoking on peripheral arterial insufficiency among smokers (n=20) and nonsmokers (n=20); aged between 40-60 years; and not suffering from any cardiovascular disease. Participants were matched on gender, body mass index (kg/m2 ) and age (years). A clinical examination utilising the Huntleigh<ill Dopplex Assist was used to measure the ABPI and quantitatively analyse the Doppler arterial waveforms on the selected study population.

Results: The mean age of the participants was 49.93 (± 5.92). Only 1 smoker had a low ABPI (<0.90) while the rest had normal ABPI scores. There was no significant difference in mean ABPI scores between smokers and non-smokers (p-values= left limbs, 0. 729; right limbs, 0. 730) however significant difference was noted in the Doppler waveforms on all arteries assessed between the two groups (p-values= <0.05), with smoking associated with significantly abnormal Doppler waveforms.

Conclusion: Low ABPI is indicative of PAD and it increases the risk of cardiovascular morbidity and death as reviewed in the literature, but a normal ABPI does not preclude peripheral arterial disease in a selected population of middle-aged smokers, as seen in this study. Quantitative Doppler waveform analysis utilising a hand-held Doppler may reveal arterial insufficiency in asymptomatic smoking subjects with normal ABPI scores. It is therefore concluded that in middle aged smokers with no concomitant cardiovascular risk characteristics, routine assessment of pedal waveforms is important in order to prevent complications attributable to PAD.