Smoking Cessation Linked to Fewer PAD Events

Complete smoking cessation after a diagnosis of peripheral artery disease (PAD) was associated with lower risks of major cardiovascular and limb events, whereas reducing cigarette consumption without quitting was not associated with significant benefit, according to a cohort study published in JAMA Network Open.

The nationwide, population-based retrospective study included 189,545 active smokers aged 40 years or older with newly diagnosed PAD in South Korea. The cohort had a mean age of 54.2 years, and 88.5% of participants were men. Using self-reported information from health examinations, investigators classified participants as quitters, reducers who decreased daily cigarette consumption by at least 20%, or maintainers who reported a smaller reduction, no change, or increased consumption.

Compared with maintainers, quitters had lower risks of major adverse cardiovascular and cerebrovascular events (hazard ratio [HR], 0.88; 95% CI, 0.84-0.91) and major adverse limb events (HR, 0.83; 95% CI, 0.73-0.94). Reducers did not have statistically significant risk reductions for either outcome.

The observational design does not establish that smoking cessation caused the lower event rates. Smoking status was self-reported without biochemical confirmation, and the PAD case definition was not formally validated. The authors also noted the possibility of healthy-participant bias, unmeasured confounding from concurrent lifestyle changes or treatments, and smoking-behavior changes between examinations.

The findings support complete cessation as the therapeutic goal for patients with PAD rather than treating smoking reduction as an equivalent endpoint. The authors noted that previous research in other populations found that multimodal approaches combining pharmacotherapy, behavioral support, and structured follow-up were associated with higher sustained cessation rates.

Source: Kim HK, Kim M, Ahn S, et al. Smoking behavior and major cardiovascular and limb events in patients with peripheral artery disease. JAMA Netw Open. 2026;9(8):e2629337. doi:10.1001/jamanetworkopen.2026.29337