[Effect of smoking on the incidence of adverse outcomes and ischemic wounds in peripheral artery disease].

Przeglad lekarski Pub Date : 2016-01-01
Ewa Strauss, Marta Stelcer, Pawel Zawadzki, Jolanta Tomczak, Grzegorz Oszkinis
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Abstract

Background: Smoking is a major risk factor for peripheral artery disease (PAD), which correlates with progression of the disease, the prevalence of chronic wounds, amputation incidence and mortality. On the other hand, abstinence from smoking has a beneficial effect on the bypass grafts patency after surgical revascularization. Poland fits in the steady decline in the percentage of smokers, but there is a lack of current data, whether those changes are observed also in patients with PAD and whether they lead to the improvement of health condition.

Objective: This study evaluated the impact of smoking and other known risk factors for cardiovascular disease on the occurrence of PAD, the risk of adverse outcomes (death, amputation, tissue necrosis), development of chronic wounds and their healing after arterial revascularization.

Materials and methods: The study was conducted in groups of 208 patients with PAD scheduled for surgical treatment (28.4% of patients with adverse outcomes of PAD, 38.5% of patients with ischemic wounds) and 190 control subjects. The study groups were interviewed concerning smoking, characterized by known risk factors for cardiovascular disease, and in the incidence of amputation, and deaths within 30 days after surgery. In the group of 48 patients with ischemic wounds a prospective assessment of the progress of wound healing in terms of changes in the wound advancement and changes in pain severity associated with wounds was performed.

Results: Over 90% of patients with PAD were smokers: 53.8% former and 36.5% past in relation to 27.4% and 14.7%, respectively, in the control group (p <0.0001). Among patients, a higher proportion of former smokers was found in those with poorer health condition: with adverse outcomes of PAD (48.0% vs 64.1%, p <0.05), and with ischemic wounds (70.7% vs 65.1%, p = 0.056). Advanced age, female sex, and the presence of diabetes were associated with both, the presence of PAD adverse outcomes, as well as the development of ischemic wounds. In the prospective study, major factors prolonging the process of wound healing were advanced age, diabetes and smoking (evaluated as peaks years of smoking).

Conclusions: Smoking is still the most common risk factor for PAD, and smoking cessation is the result of the deterioration of health condition. Simultaneously this factor, in addition to diabetes, advanced age and female sex, affects both the risk of unfavorable course of PAD and decrease the progress of wound healing. Control of risk factors for cardiovascular disease should be especially careful in women in whom, despite the lower PAD incidence, further prognosis of disease progression seem worse.

吸烟对外周动脉疾病不良结局和缺血性损伤发生率的影响
背景:吸烟是外周动脉疾病(PAD)的主要危险因素,与疾病进展、慢性伤口患病率、截肢发生率和死亡率相关。另一方面,戒烟对搭桥血管重建术后血管通畅有有益的影响。波兰符合吸烟者百分比稳步下降的情况,但缺乏当前的数据,这些变化是否也在PAD患者中观察到,以及它们是否导致健康状况的改善。目的:本研究评估吸烟和其他已知的心血管疾病危险因素对PAD的发生、不良结局(死亡、截肢、组织坏死)的风险、动脉血运重建术后慢性伤口的发展及其愈合的影响。材料和方法:本研究分为两组,分别为208例手术治疗的PAD患者(28.4%的PAD不良结局患者,38.5%的缺血性伤口患者)和190例对照组。研究组接受了关于吸烟的访谈,其特点是已知的心血管疾病危险因素,以及截肢的发生率和术后30天内的死亡。在48例缺血性伤口患者组中,根据伤口进展的变化和伤口相关疼痛严重程度的变化,对伤口愈合的进展进行了前瞻性评估。结果:90%以上的PAD患者为吸烟者,其中既往吸烟者占53.8%,既往吸烟者占36.5%,对照组吸烟者占27.4%,既往吸烟者占14.7%。(p)结论:吸烟仍是PAD最常见的危险因素,戒烟是健康状况恶化的结果。与此同时,除糖尿病、高龄和女性外,这一因素也会影响PAD不良病程的发生风险和降低伤口愈合的进展。对心血管疾病危险因素的控制应特别小心,尽管PAD发病率较低,但疾病进展的进一步预后似乎更差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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