As a vascular surgeon, I often meet patients who come to me with complaints of leg pain, difficulty in walking, or non-healing wounds on their feet. When I examine them and run diagnostic tests, I find a common factor behind many of these cases: smoking.
In India, where smoking prevalence among men is still significant, it has become one of the leading contributors to Peripheral Arterial Disease (PAD). This condition silently narrows the arteries of the legs, reduces blood flow, and over time, threatens not only mobility but also life itself.
The link between smoking and PAD is strong, direct, and well established. In fact, research shows that smokers are up to four times more likely to develop PAD than non-smokers. Even more concerning, smoking does not just trigger PAD; it accelerates its progression and increases the risk of serious complications such as amputations. In my practice, I see this reality unfold regularly, and it serves as a reminder of how critical it is to address smoking when discussing vascular health.
Let us understand what PAD is, how smoking causes it, and why quitting tobacco is one of the most powerful treatments for protecting your arteries and your future.
What is Peripheral Arterial Disease (PAD)?
Peripheral Arterial Disease is a vascular condition where fatty deposits, known as plaques, build up in the arteries that supply blood to the legs. This process is called atherosclerosis. As the arteries become narrowed or blocked, the blood supply to the muscles and tissues reduces significantly. The most common peripheral artery disease symptoms include leg pain while walking, known as claudication, numbness, coldness in the feet, slow-healing wounds, and, in severe cases, gangrene.
PAD is more than just a problem of the legs. It is a red flag for widespread vascular disease. Patients with PAD are at a much higher risk of heart attack and stroke because the same atherosclerotic process affects other arteries in the body. For this reason, timely diagnosis and proper peripheral artery disease treatments are essential.
When patients come to a peripheral artery disease clinic, we evaluate them using non-invasive tests like the ankle-brachial index and Doppler ultrasound. In certain cases, advanced imaging and peripheral artery disease procedures may be needed to confirm the severity and plan further treatment.
Smoking as a Major Risk Factor
Among all the risk factors for PAD, smoking stands out as the most preventable one. Diabetes, high blood pressure, and high cholesterol certainly play important roles, but smoking directly damages the arteries in a unique and aggressive way. In fact, almost every patient I treat for PAD who smokes notices a much faster deterioration in their condition compared to non-smokers.
Studies in India and across the world consistently show that smoking not only increases the likelihood of developing PAD but also doubles the risk of complications after peripheral artery disease surgery. It interferes with the body’s natural healing ability, reduces oxygen delivery, and makes even the best surgical interventions less effective.
How Smoking Causes PAD
Mechanisms of Damage
When you smoke, harmful chemicals like nicotine and carbon monoxide enter your bloodstream. Nicotine causes blood vessels to constrict, which reduces blood flow. Carbon monoxide lowers the oxygen-carrying capacity of the blood. Over time, these effects injure the inner lining of the arteries, known as the endothelium. This injury allows cholesterol and fat to deposit, forming plaques.
Additionally, smoking increases the tendency of blood to clot. In patients with PAD, this raises the risk of complete artery blockages, leading to sudden and severe complications such as acute limb ischemia.
Severity and Progression
Smokers with PAD tend to experience symptoms earlier and with greater severity. The distance they can walk without pain is often significantly shorter than non-smokers with PAD. They also have higher chances of developing critical limb ischemia, a stage where even resting causes severe pain and non-healing ulcers. At this stage, the risk of amputation becomes dangerously high.
In my own clinical experience, I have seen patients who continue smoking even after being diagnosed with PAD deteriorate rapidly. Their wounds refuse to heal, their bypass grafts fail, and they often require repeated interventions. On the other hand, patients who quit smoking early often see stabilization of their disease and much better outcomes.
Health Consequences
PAD is not only about the legs. Because smoking affects arteries throughout the body, PAD patients who smoke are more likely to suffer heart attacks and strokes. In fact, data show that PAD patients who continue smoking have a two to three times higher risk of dying from cardiovascular causes compared to those who quit.
Thus, smoking does not just affect circulation in your legs; it is a systemic assault on your vascular health.
Benefits of Quitting Smoking
One of the most positive aspects of PAD is that quitting smoking, at any stage, brings immediate and long-term benefits. Patients often ask me if quitting will make a difference after years of smoking. The answer is always yes.
When a patient quits smoking, blood circulation improves almost immediately. Oxygen delivery increases, artery function begins to recover, and the risk of clotting decreases. Over the next few months, walking distance without pain improves, and wounds start to heal better.
Long-term benefits are even more significant. The chances of needing peripheral artery disease surgery or amputation decrease. The risk of heart attack and stroke reduces dramatically. For patients who undergo peripheral artery disease procedures like angioplasty or bypass surgery, quitting smoking ensures that these treatments last longer and provide better results.
In India, where awareness about PAD is still developing, I strongly advise patients to consult a doctor to consult for PAD as early as possible. Specialized peripheral artery disease specialists can guide you not only through the medical and surgical aspects but also provide support for lifestyle modifications like smoking cessation.
Conclusion
Smoking is one of the most destructive risk factors for Peripheral Arterial Disease. It not only causes PAD but also accelerates its severity, makes treatments less effective, and significantly raises the risk of heart attack, stroke, and limb loss. The good news is that quitting smoking is the single most effective step you can take to protect your arteries and improve your health outcomes.
As a vascular surgeon in India, I have witnessed both sides of this story. Patients who continue smoking struggle with repeated procedures, amputations, and poor quality of life, while those who quit smoking early often stabilize and lead active, healthier lives. If you or your loved ones are facing peripheral artery disease symptoms, I strongly recommend visiting a dedicated peripheral artery disease clinic. With timely diagnosis, appropriate peripheral artery disease treatments, and most importantly, quitting smoking, it is possible to control PAD and prevent its worst outcomes.
Frequently Asked Questions
Smoking damages the inner lining of arteries, causes them to narrow, reduces oxygen delivery, and promotes plaque buildup and clot formation. These changes reduce blood flow to the legs, leading to PAD.
Quitting smoking does not remove existing plaques, but it prevents further damage, improves circulation, and slows disease progression. In many cases, symptoms improve significantly after quitting.
The best way to stop PAD progression is to quit smoking, manage diabetes and blood pressure, exercise regularly, and follow medical advice. Consulting peripheral artery disease specialists ensures you receive the right treatments and procedures when needed.
Dr. Sumit Kapadia
MBBS, MS, MRCS, DNB-Fellow
