The association of smoking and erectile dysfunction: results from the Fangchenggang Area Male Health and Examination Survey (FAMHES)

To describe the prevalence of erectile dysfunction (ED) and its association with smoking and other risk factors among a large male population. Data were collected from 2686 men attending the Fangchenggang Area Male Health and Examination Survey from September 2009 to December 2009. ED was assessed using the 5-item International Index of Erectile Function. Self-reported smoking history was obtained from the questionnaire. Prevalence of ED was 49.5% among 2686 Chinese men in Fangchenggang aged 20-79 years. After adjusting for age, alcohol drinking, physical activity, hypertension, diabetes, dyslipidemia, and obesity, smokers who smoked ≥20 cigarettes daily had a significantly increased risk of ED than never smokers (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.03-1.49; P = .02). After further adjustment for education, the risk of ED was still significantly higher in men smoking more than 23 years than never smokers (OR, 1.60; 95% CI, 1.22-2.09; P = .001). Association of age and education with ED was statistically significant after adjusting for the other variables. A history of diabetes and hypertension all increased the risk of ED, but statistically significant differences did not exist after adjustment for other variables. The association between smoking and ED risk in men was higher with a habit of drinking alcohol (OR, 1.32; 95% CI, 1.01-1.74) or physical inactivity (OR, 1.33; 95% CI, 1.05-1.67), or with a with a history of hypertension (OR, 1.71; 95% CI, 1.11-2.62), dyslipidemia (OR, 1.39; 95% CI, 1.06-1.81), and diabetes (OR, 2.69; 95% CI, 1.4-6.98). Our results show that heavy smoking might cause ED and that the duration of the habit increases the risk of ED. Furthermore, it highlights the potential interaction of smoking with other life habits or medical history on ED risk.     

Prevalence of chronic cough and phlegm among male cigar and pipe smokers: results of the Scottish Heart Health Study.

BACKGROUND--Previous studies investigating the effect of cigar or pipe smoking on the occurrence of chronic cough and chronic phlegm have reported prevalences among cigar and pipe smokers lying between those of non-smokers and current cigarette smokers. This study uses data on previous cigarette consumption, current cigar or pipe consumption, and biochemical markers of smoking to provide a detailed analysis of chronic cough and chronic phlegm among cigar and pipe smokers. METHODS--A total of 10,359 men and women aged 40-59 years were sampled for the Scottish Heart Health Study between 1984 and 1986. Prevalence of chronic cough and chronic phlegm among male cigar and pipe smokers (non-cigarette smokers) was compared with those who had never smoked, between ex-smokers of cigarettes and those who had never smoked cigarettes, between cigar-only and pipe-only smokers, and by cigar or pipe consumption levels. RESULTS--In all, 463 ex-smokers of cigarettes and 154 who had never smoked cigarettes were cigar or pipe smokers; 1080 had never smoked any form of tobacco. Ex-cigarette smokers smoked and inhaled more than those who had never smoked cigarettes. Among the ex-cigarette smokers, cigar or pipe smokers had 1.63-1.71 times the prevalence of both chronic cough and chronic phlegm than those who had never smoked (1.31-1.36 among cigar only smokers; 2.23-2.84 among pipe only smokers). A strong positive dose-response effect was found between the prevalence of symptoms and cigar or pipe consumption. CONCLUSIONS--Cigar and pipe smokers have a higher prevalence of chronic cough and phlegm than those who have never smoked, and the difference is more marked in pipe-only smokers than in cigar-only smokers. Both categories show a positive dose-response effect. Among cigar and pipe smokers, ex-cigarette smokers have a higher prevalence of symptoms than those who have never smoked cigarettes, which may be because they inhale more or may be attributable to previous cigarette smoking.     

Relationship between smoking and erectile dysfunction

We estimated the effects of smoking on the risk and prognosis of erectile dysfunction (ED), and of ED on smoking behavior. The follow-up sample consisted of the 1442 men aged 50-75 y, who responded to both baseline and follow-up questionnaires. We estimated the effect of smoking on the incidence of ED among the 1130 men free from ED, ED on risk to start smoking in the 502 nonsmokers, smoking on the prognosis of ED among the 312 with ED and ED on quitting smoking among the 292 current smokers at baseline. Risk of ED increased nonsignificantly with smoking (odds ratio (OR)=1.4), while ED recovery reduced (OR=0.6). Therefore, there was the ratio of 2.3 (1.4/0.6) describing the total effect of smoking on the risk of ED. Both quitting (OR=1.7) and starting (OR=1.9) smoking were rare and nonsignificantly higher in men with ED. Most of the OR estimates on smoking-ED relationships were not statistically significant, probably due to small numbers. There are two bidirectional relations between ED and smoking. Those who smoked had a higher risk of ED than nonsmokers. The men with ED were more likely to start smoking than those free from ED. The estimates of effects were not statistically significant, but they were consistent with each other and with the hypothesis that smoking causes ED and ED causes smoking. The recovery from ED was less in smokers than among nonsmokers, and current smokers with ED were more likely to stop smoking than men free from ED. Numbers were few and estimates of effects were not significant, but consistent with the hypothesis of smoking preventing recovery from ED and ED improving the success of smoking cessation. Such transitions in four directions explain indirectly the known positive association between the prevalence of smoking and the prevalence of ED.     

Cigarette smoking as risk factor for erectile dysfunction: results from an Italian epidemiological study

OBJECTIVES: We analysed the role of smoking on the risk of erectile dysfunction (ED) using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. METHODS: A total of 2010 men aged more than 18 years were randomly identified and interviewed by 143 general practitioners among their registered patients. Patients were asked "about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance." If they were dissatisfied, they were defined as having ED. RESULTS: In comparison with never smokers, current smokers had an odds ratio (OR) of ED of 1.7 (95% confidence interval (CI), 1.2-2.4) and ex-smokers of 1.6 (95% CI, 1.1-2.3). The association between smoking and ED risk was present in subjects without a history of any cardiovascular disease, cardiopathy, hypertension, diabetes and neuropathy, but not in those with a history of these conditions. For example, the ORs of ED in smokers, in comparison with never smokers, were respectively 2.4, 2.0 and 1.7 in men with no history of any cardiovascular disease, diabetes and neuropathy, but respectively 1.0, 1.0 and 1.2 in those with a history of the conditions. CONCLUSIONS: This study shows that the risk of ED is influenced by smoking and that the duration of the habit increases the risk. Further, it highlights the potential interaction of smoking with medical history on ED risk.     

Smoking patterns in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of tobacco-smoking habits in a random sample of 976 coloured subjects aged 15-64 years revealed that smoking was common, 57% of men and 41% of women being current smokers and 10.4% of men and 9.6% of women having stopped smoking. Heavy smoking prevailed, indicating by mean daily consumption of 14.2 and 13.1 cigarettes among male and female smokers respectively; only 33.5% of male and 39.6% of female smokers used less than 10 cigarettes per day. Coloured smokers smoked more heavily during the weekend. Both men and women smoked mostly filter cigarettes. Forty-four per cent of male and 49.5% of female smokers stated that they had attempted to stop smoking, mainly for health reasons. More than one-third of the participants had a positive attitude to combating smoking, particularly those with an educational level higher than Standard 7. Former smokers and heavy smokers had a significantly higher prevalence of ischaemic heart disease than the other participants. Smoking was associated with a low body mass index, low high-density lipoprotein cholesterol levels, low socio-economic standing, high alcohol consumption and type A coronary-prone behaviour in men. In 1982 the economically active coloured population of the Cape Peninsula spent an estimated R36.2 million on cigarettes.     

The association between cigarette smoking and back pain in adults.

STUDY DESIGN: A retrospective cohort study of adolescent idiopathic scoliosis. A comparison group of persons without scoliosis was also selected randomly from the general population. OBJECTIVES: To estimate the association between level of cigarette smoking and the prevalence and severity of back pain. METHODS: A postal questionnaire was used to elicit information on smoking histories, a variety of indices of low back pain, and potential confounding factors. The association between smoking and back pain was estimated separately for men and women in the cohort and in the comparison group using ordinal regression models. RESULTS: The questionnaire was completed by 1287 women and 184 men who had adolescent idiopathic scoliosis and by 1130 women and 621 men in the comparison population who did not have scoliosis. Statistically significant associations between back pain and current cigarette smoking were found in the two groups of women and men with scoliosis, but not among men selected from the general population. In the three former groups, proportional odds ratios comparing current smokers to persons who never smoked ranged from 1.4 to 1.9. Among current smokers, the prevalence of back pain increased with cigarette consumption, and the proportional odds ratios ranged from 1.2 to 1.8 per 10 pack-years (no. of cigarettes smoked per day x no. of years/20). In these three groups, intensity, frequency, and duration of episodes of back pain also were found to increase with smoking consumption. CONCLUSION: The finding that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain, and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.     

Heavy smoking is an important risk factor for erectile dysfunction in young men

Clinical and basic science studies provide strong indirect evidence that smoking may affect penile erection. The objective of this retrospective research was to investigate the role of smoking for erectile dysfunction (ED) in order to obtain some insight into the prevention of ED. We reviewed the data from 860 male patients aged between 18 and 44 visited during the period January 1999 to December 2002. The patients were divided into three groups: smokers, never smokers and former smokers. All patients were submitted of medical history, such as, IIEF 5 Questionnaire, physical examination, serum levels of glucose, cholesterol, prolactin and free testosterone. Our data were compared with ISTAT (Italian Institute of Statistics) and data on the Italian population of smokers. We have stratified the data by age and area of residence. The 860 patients, mean age 32.4 y old (range 18-44), are distributed into three groups: smokers 460 (53.5%), never smokers 320 (37.2%) and former smokers 80 (9.3%). Current smokers in our series are 460 (53.5%) in comparison to 34.7% of male current smokers in Italy, in the same range (18-44). Out of 860, 337 are patients who smoked more than 20 cigarettes per/day (39.2%) and these data are extremely interesting; while comparing the same aged men through ISTAT, it is found that only 4% are heavy smokers. On analysing the incidence of heavy smoking in middle-aged patients affected by ED with the whole Italian population by means of ISTAT, taking into account males with the same age range and area of residence, it was shown that the data of our population (sample) compared all Italian middle-aged patients are 39.2 vs 4%; this explains the need for education within a comprehensive smoking cessation programme, and should be reserved especially for young smokers, in order to be aware and informed of the effect of tobacco on erectile function.     

Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study

OBJECTIVE: To assess whether stopping smoking can improve erectile dysfunction (ED) in smokers, as cigarette smoking is a known risk factor for ED. PATIENTS AND METHODS: Smokers who requested nicotine replacement therapy (NRT) and complained of ED were first evaluated for hypertension, dyslipidaemia, diabetes, psychiatric disorders and drug history. The grade of ED in smokers with none of these risk factors was then determined using the five-item version of the International Index of Erectile Function (IIEF-5) before NRT, and the grading repeated after 1 year of follow-up. The correlation between the exposure to smoking (pack-years) and severity of ED was assessed before the follow-up. The ED status between patients who stopped smoking after NRT and those who continued during the follow-up was then compared before and after the follow-up. RESULTS: The severity of ED correlated significantly with the level of exposure to smoking. Age and ED status before the follow-up were not significantly different between 118 patients who stopped (ex-smokers) and 163 who continued smoking (current smokers). After 1 year the ED status improved in > or = 25% of ex-smokers but in none of the current smokers; 2.5% of ex-smokers and 6.8% of current smokers had a deterioration in ED. Ex-smokers had a significantly better ED status after the follow-up (P = 0.009). Among ex-smokers, patients with advanced ED and those who were older had less improvement. CONCLUSION: There is a strong association between the intensity of cigarette smoking and degree of ED. Stopping cigarette smoking can improve ED in a considerable proportion of smokers. Age and the severity of ED before stopping are inversely related to the chance of improvement.     

Cigarette smoking: a risk factor for erectile dysfunction in diabetics.

OBJECTIVES: Diabetes is one of the systemic disorders most frequently associated with erectile dysfunction (ED). An extensive literature documents well the relationship between ED and several factors related to diabetic pathology, but the role of risk factors mainly related to life-style, e.g. cigarette smoking, is still not defined. METHODS: Eligible for the study were men aged 20-70 years with a diagnosis of insulin-dependent (type 1---IDDM) or non-insulin-dependent (type 2--NIDDM) diabetes who were observed on randomly selected days in 178 diabetes centers in Italy. ED was defined as a failure to achieve and maintain an erection sufficient for satisfactory sexual performance. RESULTS: The study population consisted of 9,670 diabetic men. Of these 2,962 (30%) were never smokers, 2,877 (30%) current smokers and 3,831 (40%) ex-smokers. After taking into account the effect of age, the odds ratios of ED in comparison with never smokers was 1.4 (95% confidence interval 1.3-1.6) for smokers and 1.5 (95% confidence interval 1.3-1.6) for ex-smokers. Duration and intensity of the smoking habit was associated with an increased risk of ED. Among ex-smokers, the risk of ED significantly decreased; with increase in the number of years since the patient quit smoking. CONCLUSION: The study offers an assessment of the association between smoking habit and ED and its potential interaction with other risk factors in diabetic men.     

Smoking as a risk factor for erectile dysfunction: data from the Andrology Prevention Weeks 2001-2002 a study of the Italian Society of Andrology (s.I.a.)

OBJECTIVE: To analyse the relationship between smoking and erectile dysfunction (ED). METHODS: To provide further data on this issue, we analysed information gathered from men attending a free andrologic consultation in 234 Italian medical centres, in the setting of a project focused on andrologic prevention. Men were asked about "their ability to achieve and maintain an erection sufficient for satisfactory sexual performance". If they were dissatisfied, they were defined as having ED. RESULTS: Out of 16724 subjects, ED was diagnosed in 4081 men (24.4%). After adjustment for age, marital status, education, alcohol consumption, physical activity and concomitant pathologies, in comparison with never smokers, men who currently smoked more than 10 cigarettes/day and former smokers showed significantly higher odds ratio (ORs 1.4 and 1.3, respectively) for ED. These results were confirmed performing analysis in strata of diabetes, hypertension, cardiovascular disease and hypercolesterolemia. COMMENTS: This transversal observational study shows that the risk of ED is influenced by smoking. A dose- and duration-response effect is present; changes in smoking habits do not seem to significantly affect the risk to develop ED.     

Nocturnal penile tumescence in cigarette smokers with erectile dysfunction.

We examined the relationship between cigarette smoking and erectile physiology in 314 men with erectile dysfunction. All of the men studied were currently cigarette smokers. Evaluations included interviews, physical examinations, and polysomnographic assessment of sleep-related erections. Penile rigidity during nocturnal erection inversely correlated with the number of cigarettes smoked per day. Smoking was also associated with indices of impairment on autonomic function tests and some measures of penile blood pressure. The group of men who smoked the most (more than 40 cigarettes per day) had the fewest minutes of nocturnal tumescence and detumesced fastest. These data are discussed with respect to the results of studies performed in dogs that demonstrated smoking-related reduction in arterial flow and venous restriction. Our findings suggest that smoking may further compromise penile physiology in men experiencing difficulty in maintaining erections long enough for satisfactory intercourse.     

Pronounced risk of nontraumatic osteonecrosis of the femoral head among cigarette smokers who have never used oral corticosteroids: a multicenter case–control study in Japan

BackgroundCigarette smoking has been linked to an increased risk of nontraumatic osteonecrosis of the femoral head (ONFH) in previous studies. However, the effect of smoking amount, duration and cessation, and interaction with corticosteroids remains unclear. The purpose of this study was to precisely evaluate the effects of smoking and the interaction with corticosteroid use.MethodsThis was a multicenter, matched case–control study in Japan. Cases were defined as patients who were newly diagnosed with ONFH at an initial visit or during the previous year if they were referred patients. For each case, matched controls were selected from patients without ONFH. The matching conditions were sex, age, and ethnicity. A logistic regression model was used to compute odds ratios (OR) and 95 % confidence intervals (95 % CI).ResultsWe compared 72 cases with 244 matched controls. ORs were 3.89 (95 % CI 1.46–10.4) for current smokers, 3.89 (1.22–12.4) for smokers consuming more than 20 cigarettes per day, 4.26 (1.32–13.7) for smokers with 26 pack–years or more, and 3.11 (0.92–11.5) for smokers with a history of 29 years or more, with significant or marginally significant dose–response relationships. OR for current smokers was 10.3 among those who had never used corticosteroids and 1.56 among past or current corticosteroid users (P for interaction 0.010).ConclusionsOur results revealed that heavier cigarette smoking was associated with a higher risk of ONFH. The elevated risk from cigarette smoking was markedly pronounced among those who had never used oral corticosteroids.     

Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China

AIM: To evaluate the correlates of erectile dysfunction (ED) in Hong Kong middle-aged Chinese men aged 45-64 years. METHODS: A community-based cross-sectional household survey was performed in Hong Kong. The Chinese abridged version of the International Index of Erectile Function (IIEF-5) was used to measure erectile function. The International Prostate Symptom Score (IPSS) was used to measure lower urinary tract symptoms (LUTS) and depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Demographic and lifestyle data were also collected. The association between ED and its correlates was analyzed using bivariate and multivariate analyses. RESULTS: Of the 545 subjects who agreed to participate in the survey, 75 refused to answer questions about their sexual activities and function. Out of those who responded, 118 (22%) subjects were not sexually active (not sexually active over the past 4 weeks). Out of 352 subjects, 60.3% suffered from some degree of ED. Age, presence of depression defined by CES-D and moderate LUTS were associated with increased odds of having ED. In multivariate analysis, depressive symptoms identified by CES-D (OR = 2.3, CI: 1.2-4.6) and moderate LUTS (OR = 3.7, CI: 1.6-8.3) were independently associated with increased odds of having ED. CONCLUSION: ED is an important public health problem in Chinese middle-aged men, with more than half suffering from some degree of ED. Depression and LUTS were significant and important risk factors associated with ED.     

The prevalence of Peyronie's disease in diabetic patients with erectile dysfunction

We attempted in this study to investigate the prevalence of Peyronie's disease (PD) among diabetic patients with erectile dysfunction (ED). Two-hundred and six diabetic patients were further evaluated in this study. Forty-two (20.3%) patients had PD. There were significant associations between PD and risk factors of age, obesity and smoking. All patients with PD had also ED. Penile curvature was present in 82.1% of all patients with PD. Of the patients with PD, 25.4% had pain with or without erection. Significant associations between PD and ED and ED duration were detected. This study confirmed the high prevalence of PD among diabetic patients with ED. Further work is needed probing the mechanisms through which diabetes affects the pathogenesis of ED and PD.     

Frequency and determinants of erectile dysfunction in Italy

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction (ED) in Italy in a cross-sectional study. METHODS: Eligible for the study were men aged 18 years or more, randomly identified by 143 general practitioners among their registered patients during the period January 1996 to February 1997. ED was defined as the impossibility to achieve and maintain an erection sufficient for satisfactory sexual performance. RESULTS: Of the 2, 010 men interviewed, 257 (12.8%) reported ED. The prevalence increased with age, from 2% in men aged 18-39 to 48% in those >70 years (tested for trend, p = 0.0001). A history of cardiopathy, diabetes, hypertension, neuropathy, thrombotic/hemorrhagic stroke, peripheral vascular disorders, pelvic/medullary injury and pelvic surgery/radiation all increased the risk of ED. The association of hypertension and diabetes tends to increase the risk of ED. In comparison with nondiabetic and nonhypertensive men, the odds ratio (OR) was 1.4 (95% confidence interval (CI), 0.7-3.2) for hypertensive men without diabetes, 4.6 (95% CI, 1.6-13.7) for diabetic men without hypertension and 8.1 (95% CI, 1.2-55.0) for men with diabetes and hypertension. In comparison with never smokers, the OR of ED was 1.7 (95% CI, 1.2-2.4) for current smokers and 1.6 (95% CI, 1.1-2.3) for ex-smokers and increased with duration of the habit. CONCLUSIONS: The study offers a quantitative estimate of the prevalence of ED and of its main risk factors in Italian men.     

Association between smoking, passive smoking, and erectile dysfunction: results from the Boston Area Community Health (BACH) Survey

INTRODUCTION: Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking. METHODS: The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30-79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses. RESULTS: An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR]=1.68; 95% confidence interval [CI], 1.03, 2.30 for > or =20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR=1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10-19 pack-years of active smoking (adjusted OR=1.25; 95%CI, 0.68, 2.30). CONCLUSIONS: Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with > or =20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10-19 pack-years of active smoking.     

Adverse Effects of Smoking on Peak Bone Mass May Be Attenuated by Higher Body Mass Index in Young Female Smokers

Smoking is associated with postmenopausal bone loss and fracture, but the effect of smoking on bone in younger women is unclear. Peak bone mass is an important determinant for fracture risk; therefore, our aim was to evaluate the association between smoking and bone mass in 25-year-old women, specifically the influence of daily cigarette consumption and total exposure, duration, age at starting smoking, and time since smoking cessation on bone density and fracture risk. Smoking and bone mineral density (BMD) data were available for 1,054 women from the PEAK-25 cohort. Analyses comparing current smokers with women who never smoked were performed using number of cigarettes per day, pack-years, smoking duration, age smoking started, and, for former smokers, age at quitting. BMD did not differ between never, former, and current smokers; and the relative fracture risk in smokers was not significant (relative risk [RR] = 1.2, 95 % confidence interval 0.8–1.9). Among current smokers, BMD decreased with a dose response as cigarette consumption increased (femoral neck p = 0.037). BMD was not significantly lower in young women who had smoked for long duration or started smoking early (p = 0.07–0.64); long duration and early start were associated with higher body mass index (BMI; p = 0.038). Lower BMD persisted up to 24 months after smoking cessation (p = 0.027–0.050), becoming comparable to never-smokers after 24 months. Hip BMD was negatively associated with smoking and dose-dependent on cigarette consumption. Smoking duration was not associated with BMD, although young women with a long smoking history had higher BMI, which might attenuate the adverse effects from smoking.     

Smoking practices in the black township population of Cape Town

A smoking prevalence survey was conducted in the black township population of Cape Town in order to assist with the planning of an anti-smoking campaign. Three townships were selected to reflect different levels of urbanisation: Langa (a settled urban community), Site B (a population of recent arrivals in the urban environment) and Khayelitsha (of intermediate urban status). Using World Health Organisation guidelines a school survey and an adult survey were conducted in each area. Of the 673 school pupils who were interviewed, 0.8% of girls and 23.7% of boys were current smokers. There was a trend to increasing smoking prevalence with increasing age among boys. After age-adjustment there was no difference in smoking prevalence between boys at the three schools. Information from 1320 adult respondents and 1,401 proxy-reported adults yielded an overall smoking prevalence of 7% (95% confidence interval 5.6-8.4%) for women and 60% (95% confidence intervals 57.5-62.5%) for men. Two-thirds of male smokers were smoking 10 or more cigarettes per day. The preferred mode of tobacco consumption in 87% of adults and 91% of school pupils was manufactured cigarettes. The survey has established three target groups for intervention in the black townships of Cape Town: boys in their early teens for prevention of initiation of smoking; adult men for assistance with smoking cessation; and girls and women to maintain their non-smoking status.     

Prevalence of peripheral arterial disease and its association with smoking in a population-based study in Beijing, China

OBJECTIVE: Although the prevalence of peripheral arterial disease (PAD) and its association with smoking in Western populations has been extensively studied, little information is available in China. The objective of this study was to determine the age-standardized prevalence of PAD and examine the relationship between smoking, quitting, and PAD in elderly Chinese. METHODS: We conducted a population-based cross-sectional study in an urban Beijing sample of 2334 subjects aged > or =60 years (943 men and 1391 women) in 2001 to 2002. PAD was assessed by symptoms of intermittent claudication (IC) as measured by the WHO/Rose questionnaire and an ankle-arm systolic blood pressure index (AAI) of <0.90. RESULTS: The prevalence of PAD defined by IC was 11.3% (men, 8.0%; women, 13.6%); 15.3% (men, 11.7%; women, 17.7%) by AAI, and 19.8% (men, 14.7%; women, 23.2%) by both criteria. After adjusting for age, gender, marital status, education, alcohol drinking, exercise, body mass index, and histories of hypertension and diabetes mellitus, the odds ratios and 95% confidence intervals of PAD for current smokers vs never smokers were 1.54 (1.12 to 2.11) and 1.28 (0.91 to 1.79) for former smokers (stopped smoking for at least 2 years). There was a dose-response relation between the number of cigarettes smoked and increasing risk of PAD. Quitting for > or =10 years nearly eliminated excess risk associated with smoking. CONCLUSIONS: PAD is common in elderly Chinese and the prevalence is higher in women than in men. About 40% of PAD patients were asymptomatic and unaware of their condition. Cigarette smoking is a major risk factor for PAD, and smoking cessation substantially reduces the risk.     

Smoking and other lifestyle factors in relation to erectile dysfunction

OBJECTIVE: To assess the association between erectile dysfunction (ED) and various lifestyle and medical factors, including smoking and cardiovascular disease (CVD) medications, among men attending urology clinics in Kingston, Canada. SUBJECTS AND METHODS: We conducted a case-control study of men aged 50-80 years in Kingston, Ontario who agreed to participate at visits to urology clinics during 1997-99. We compared 101 men with clinically diagnosed ED and 234 controls with various benign urological conditions. All men completed a questionnaire on lifestyle and medical factors. RESULTS: Men with ED were twice as likely to be former smokers (odds ratio 2.2, 95% confidence interval, 1.2-3.9), and cumulative smoking in pack-years suggests a dose-response pattern with the risk of ED. Having diabetes was associated with double the risk of ED, and increased alcohol intake appeared to increase the risk. CONCLUSION: There was a greater risk of ED among former smokers, and the suggestion of a dose-response relationship with cumulative smoking.