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Impaired Peripheral Circulation in Veterans with Claudication is Associated with Smoking

Takehisa Iwai, Makoto Umeda, Yoshinori Inoue, Andrew W Gardner

We compared the peripheral vascular function of veterans and non-veterans with peripheral artery disease (PAD) and claudication. The circulation of the lower extremities was assessed under rest and reactive hyperemia conditions in 413 veterans and in 83 non-veterans. Veterans had more severe PAD as measured by a lower ankle/brachial index (p<0.001). Following the occlusive test, veterans had a greater relative percentage decrease in ankle systolic blood pressure (p=0.015), a greater percentage decrease in calf transcutaneous oxygen tension (p=0.035), and a blunted percentage increase in calf blood flow (p=0.031). After adjustment for current smoking status, these measures were no longer statistically different between the veterans and non-veterans. We conclude that veterans with PAD and claudication have greater impairments in macrovascular and microvascular function of the lower extremities, and greater severity of PAD than compared to non-veterans, and that these factors were primarily associated with their higher prevalence of smoking. The greater compromise in peripheral vascular measures in veterans is particularly noteworthy given that the prevalence of diabetes, hypertension, and dyslipidemia were not higher.