Abstract P391: Association of Peripheral Artery Disease With the Use of Smokeless Tobacco, Cigars, or Pipes in the Atherosclerosis Risk in Communities Study

Abstract

Background: Cigarette smoking is one of the strongest modifiable risk factors for peripheral artery disease (PAD), a disease which affects over 200 million people worldwide. Though cigarette use has decreased across time, use of cigars, pipes and smokeless tobacco remains unchanged or slightly increased. The association of PAD and non-cigarette tobacco use is not well described. Thus, we tested the hypothesis that the use of cigars, pipes or smokeless tobacco is associated with incident PAD even after adjustment for cigarette use. Methods: A total of 14,395 Atherosclerosis Risk in Communities (ARIC) Study participants with no history of prevalent PAD were followed from 1987 to 2015 for PAD events (hospitalizations with PAD diagnosis or leg revascularization). Baseline pipe, cigar smoking and smokeless tobacco use was self-reported. Multivariable-adjusted Cox proportional hazards regression was used. Results: At enrollment the 14,395 participants included in the study were on average (SD) 54 (6) years old, 55% female and 27% African American; 489 (3.4%) were current users of smokeless tobacco and 481 (3.3%) current users of cigars or pipes. A total of 1,289 incident PAD events occurred during a median of 25.9 years of follow-up. After adjustment for demographics and cigarette smoking status, risk of incident PAD was higher among current (versus never) users of smokeless tobacco [HR (95% CI): 1.66 (1.29-2.12)], though this association was attenuated with adjustment for CVD risk factors (Table). Cigar and pipe use were not associated with PAD incidence, regardless of degree of adjustment (Table). Conclusion: Active use of smokeless tobacco was associated with increased risk for incident PAD compared to non-use, independent of cigarette smoking, although this relationship was not statistically significant after adjustment for cardiovascular risk factors. No association was observed with use of pipes or cigars. Use of smokeless tobacco may increase PAD risk and could be a potential target for intervention.