Cigarette Smoking and Subclinical Peripheral Arterial Disease in Blacks of the Jackson Heart Study

BACKGROUND: Prevalence of peripheral artery disease (PAD) is significantly higher among blacks as compared with non‐Hispanic whites, but the role of cigarette smoking in PAD is understudied in blacks. We aimed to evaluate the relationship between cigarette smoking and PAD in blacks in the (JHS) Jackson Heart Study. METHODS AND RESULTS: JHS participants (n=5306) were classified by self‐reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers. We examined multivariable logistic and robust linear regression models to estimate the associations between baseline smoking status, smoking intensity, and measures of subclinical PAD (ankle‐brachial index [visit 1] and aortic calcium by computed tomography [visit 2]) to yield odds ratios and β‐coefficients (estimated adjusted difference) to compare each smoking status with never smokers (reference group). There were 3579 (68%) never smokers, 986 (19%) past smokers, and 693 (13%) current smokers self‐identified at baseline. After adjustment for covariates, current smokers had increased risk of ankle‐brachial index <1 (odds ratio, 2.2, 95% CI, 1.5–3.3) and increased risk of abdominal aortic (odds ratio, 8.4, 95% CI, 5.8–12.0) and aortoiliac calcium (odds ratio, 9.6, 95% CI, 6.7–13.7). When stratifying by smoking intensity, those smoking more than 20 cigarettes daily (1 pack) had higher likelihood of subclinical PAD by all of these measures compared with lower‐intensity use, suggesting a dose‐dependent relationship. CONCLUSIONS: In a large black cohort, cigarette smoking was associated with measures of subclinical PAD in a dose‐dependent manner. These findings highlight the association between smoking and PAD in blacks and support further research exploring the impact of interventions on smoking cessation to reduce PAD in this population.