Smoking & PAD

• • smoking ban impact and spin off behaviour change to smoking and advent of e-cigs have resulted in a reduction in % population who smoke
  • conversely increasing sedentary behaviours and food choices have resulted in an increased % population with DM2
  • net effect - diabetes is now the prime driving force behind PAD
• Smoking:

  • aids atheroma formation
  • aids atheroma rupture
• Smoking:

  • smoking releases nicotine -> activates adrenal medulla -> activates sympathetic nervous system via catecholamines -> causes vasoconstriction -> increase in total peripheral resistance -> increase in blood pressure -> causes endothelial damage
  • smoking damages beta cells in islets of Langerhans in pancreas -> causes hyperglycaemia -> caused endothelial damage via glucose attachment to endothelial walls -> atheroma formation
  • smoking releases nicotine -> directly causes endothelial damage -> atheroma formation
• Smoking also causes vessel occlusion:

  • smoking -> increase in reactive oxygen specials -> causes unstable atheromas -> sudden vessel occlusion
  • smoking -> increase in release of prothrombic factors -> sudden vessel occlusion
  • smoking -> platelet damage and reduced endothelial prostacyclin -> sudden vessel occlusion
• Smoking as a risk factor:

  • the magnitude of smoking as a risk factor is more than observed for chronic heart disease
  • smokers develop PAD 10 years earlier than non-smokers
  • smokers are more likely to progress to amputation