Journal-based CME Course: Smoking Behavior and Major Cardiovascular and Limb Events in Patients With Peripheral Artery Disease

Activity ID

15147

Expires

September 16, 2029

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Network Open

Description of CME Course

Importance  Smoking is the strongest modifiable risk factor for peripheral arterial disease (PAD), yet evidence on how postdiagnosis smoking behavior changes affect clinical outcomes remains limited.

Objective  To evaluate the association among smoking cessation, reduction, and continuation after PAD diagnosis and subsequent cardiovascular and limb-specific outcomes.

Design, Setting, and Participants  This nationwide, population-based, retrospective cohort study assessed adults 40 years or older newly diagnosed with PAD from January 1, 2011, to December 31, 2018, with follow-up through 2021, who reported active smoking before diagnosis and completed health examinations before and after diagnosis. Data were from the Korean National Health Insurance Service–National Health Information Database. Data analysis was conducted from December 2023 to November 2025.

Exposures  Postdiagnosis smoking behavior, classified as quitters (complete cessation), reducers (≥20% decrease in daily cigarette consumption), or maintainers (<20% decrease or any increase in consumption [reference group]).

Main Outcomes and Measures  Main outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause death, myocardial infarction, coronary revascularization, and ischemic stroke, and major adverse limb events (MALEs), including limb revascularization or major amputation. Inverse probability of treatment-weighted hazard ratios (HRs) were estimated using Cox proportional hazards regression models for MACCEs and Fine-Gray competing risk models for MALEs.

Results  Among 189 545 active smokers with incident PAD (mean [SD] age, 54.2 [11.8] years; 167 659 [88.5%] male), 38 952 (20.6%) quit smoking, 38 709 (20.4%) reduced consumption, and 111 884 (59.0%) maintained smoking. Compared with maintainers, quitters had significantly lower risks of MACCEs (17.8 vs 20.2 per 1000 person-years; HR, 0.88; 95% CI, 0.84-0.91) and MALEs (1.4 vs 1.8 per 1000 person-years; HR, 0.83; 95% CI, 0.73-0.94). Reducers showed no significant difference in MACCEs (HR, 1.00; 95% CI, 0.96-1.04) or MALEs (HR, 0.92; 95% CI, 0.81-1.04). Dose-response analysis showed risk reduction only with near-complete cessation. Findings were consistent across subgroups, with the largest reductions observed for myocardial infarction.

Conclusions and Relevance  In this cohort study of 189 545 active smokers with newly diagnosed PAD, complete smoking cessation was associated with lower risks of both cardiovascular and limb-specific adverse events, whereas partial smoking reduction showed no significant benefit. These findings support complete cessation as the primary therapeutic target in patients with PAD.

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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