New research confirms that smoking, diabetes, high blood pressure and highcholesterol levels can all raise men’s risk for poor circulation in the legs, otherwise known as peripheral artery disease (PAD).

According to the American Heart Association, PAD involves a narrowing of the peripheral (outside the heart) arteries, most commonly the vessels of the pelvis or legs. People with PAD are at increased risk for heart attack, stroke or mini-stroke. The condition is thought to affect 8 million to 10 million people in the United States.

The new study included nearly 45,000 U.S. men who were followed for more than two decades. During that time, 537 cases of PAD were diagnosed. Each of the four risk factors — smoking, diabetes, high blood pressure (hypertension) and high cholesterol levels — was significantly and independently associated with a higher risk of PAD.

Ninety-six percent of the men who developed PAD had at least one of the four risk factors when they were diagnosed with theartery disease, noted a team led by Michel Joosten of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

The investigators also found that men who did not have any of the four risk factors were 77 percent less likely to develop PAD than all other men in the study.

The risk of PAD tended to increase the longer a man had both type 2 diabetes and high cholesterol levels, the researchers added.

Two experts welcomed the results of the study.

“This important study is consistent with findings from earlier studies,” noted Dr. Kenneth Ong, acting chair of the department of medicine and cardiology at the Brooklyn Hospital Center in New York City. “It is well done due to its large population and long duration of follow-up.”

Dr. Maja Zaric, an interventional cardiologist at Lenox Hill Hospital in New York City, who treats many patients with PAD, also noted that risk factors associated with the artery disease are also typically linked to heart disease, but the relationship to PAD seems to be even stronger.

That’s especially true for smoking, Zaric said. “As a matter of fact, one of the study findings reports remote effects of smoking on PAD incidence even 20 years after smoking cessation,” she pointed out. “That should not discourage smokers from abstinence since the PAD risk amongst current smokers appears to be threefold higher than in former smokers.”

Zaric added, “now that the major risk factors for PAD in men have been identified, additional studies with specific clinical endpoints should be done to examine effects of risk factor and lifestyle modification. And not to forget, women should be studied in a similar fashion, as it is shown that presence of PAD amongst female patients had been under-recognized.”

The study was published in the Oct. 24/31 issue of the Journal of the American Medical Association.

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