Effect of physical inactivity and tobacco use on mortality and morbidity in revascularized patients with peripheral arterial disease: A nationwide cohort study

Abstract

AbstractImportancePhysical activity (PA) and tobacco use are key health behaviours in patients with peripheral arterial disease (PAD). Limited studies are available on effects of those behaviours in PAD after revascularization, including Asian countries where tobacco use is high.ObjectiveTo investigate the effects of PA and tobacco use on adverse clinical outcomes in patients with PAD after revascularization.DesignRetrospective cohort studySettingPopulation-based study using the Korean National Health Insurance Service (NHIS) databaseParticipantsPatients who had received revascularization for PAD between 2010-2015 were included. They were categorized as active or inactive based on the number of days per week they engaged in PA and as current or non-tobacco users (self-report).ExposuresPA and tobacco use.Main outcomesThe primary outcome was all-cause mortality. Secondary outcomes included major adverse outcome (a composite of all-cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularization).ResultsThe cohort comprised 8324 patients (mean age, 64.7 years; 76.9% male). Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had significantly better outcomes than inactive patients [all-cause mortality adjusted hazard ratio (adjHR) = 0.766 (0.685 – 0.855), major adverse outcome adjHR = 0.795 (0.719 – 0.878), MALE adjHR = 0.858 (0.773 – 0.953)]. Tobacco users had significantly poorer outcomes than non-users [all-cause mortality adjHR = 1.279 (1.124 – 1.456), major adverse outcome adjHR = 1.263 (1.124 – 1.418), MALE adjHR = 1.291 (1.143 – 1.458)].Conclusions and RelevanceEven after receiving revascularization for PAD, a sizable proportion of patients were inactive and used tobacco, leading to adverse clinical outcomes. These modifiable risk factors are systematically addressed in cardiac rehabilitation; in line with current guideline recommendations, more needs to be done to ensure cardiac rehabilitation participation in patients with PAD.