EARLY DIAGNOSIS OF ASYMPTOMATIC PERIPHERAL ARTERIAL DISEASE BY ANKLEBRACHIAL PRESSURE INDEX METHOD IN SMOKERS

Abstract

Background & Objectives: Cigarette smoking is a major risk factor for the development of atherosclerosis, coronary heart disease, acute myocardial infarction, and sudden cardiac death. Smokers are at an increased risk of developing early and asymptomatic PAD as compared to non-smokers.Ankle-Brachial Pressure index is a non-invasive vascular test measured by comparing systolic blood pressures in the ankle to the higher of the brachial systolic blood pressures, which is the best estimate of central systolic blood pressure ABPI is the gold standard screening test for the diagnosing PAD with a cut-off value of >0.9. Materials and Methods: Present study was carried out at cardiovascular function lab, Department of physiology, Government medical college, Bhavnagar, among 200 subjects, out of which 100 were Smokers and 100 were Non-Smokers, in age group of 20-50 years. Smokers were further categorized into Mild (n=44), Moderate (n=26), and Heavy (n=30) based on the smoking index.Observations and Results: The ABPI of both the limbs of Smokers was significantly lower than the non-smokers and this was further intensified among the smokers as the intensity and duration period of smoking increases amongst smokers with lowest ABPI in the Heavy Smokers and the highest ABPI in the mild smokers. Our study also found out generalized extremely significant decrease in ABPI in smokers as compared to non-smokers. A high relative risk of 4.9, odds ratio of 9.5 of asymptomatic PAD in smokers as compared to non-smokers was also observed. Conclusions: Cigarette Smoking plays a major role in degradation and decreased function of Cardiovascular System and in particular causative factor for PAD. Through this study we can educate the smokers about the adverse effects of smoking on various systems of the body particularly the lesser known and the cardiovascular system to the general population. Furthermore there is also a need to incorporate ABPI as a screening procedure in peripheral health centres.