We are launching the first-ever smoking cessation program specifically designed for smokers with poor circulation in their legs known as Peripheral Artery Disease (PAD). So, I thought it might be helpful to share why this is important, including a powerful interview with one of the most passionate interventional cardiologists I know, Dr. Yazan Khatib, where he paints the picture of the devastating impact of smoking on our arteries.
I’ve always known smoking was bad for PAD, but what I learned about exactly HOW it damages our vessels is even more alarming than I thought. Combined with what I’ve researched about smoking’s effects on our walking programs, I’m more convinced than ever that quitting smoking might be the single most powerful step you can take for your vascular health.
The Life-Shortening Math That Should Wake Us Up
You know I’m not one to sugarcoat things, so let me start with a shocking fact that stopped me in my tracks during our interview: Every single cigarette reduces your life expectancy by 11 minutes.
Think about that. If you smoke two packs a day, that’s 40 cigarettes. 40 cigarettes × 11 minutes = 440 minutes or over 7 HOURS of life lost every single day. Every. Single. Day.
That’s not just a statistic – that’s precious time you could be spending with your grandchildren, enjoying retirement, or simply living your life free from the pain and limitations of advanced PAD. And that’s just the tip of the iceberg when it comes to smoking’s effects on your body.
The Harsh Reality No One Is Safe From
When I asked Dr. Khatib about who’s most at risk from smoking’s effects, his answer was sobering: No one is safe from the ill effects of smoking. He shared a heartbreaking example from the CDC website about Brandon, a young man who lost both legs at the age of 18 due to Buerger’s disease, a condition triggered by tobacco use.
This hit me hard. PAD isn’t just a disease of older adults. Young people who smoke can develop severe vascular problems that lead to amputations decades before most people even start worrying about their circulation.
What’s more shocking? Dr. Khatib has personally treated patients under 30 years old who have lost legs due to smoking-related vascular disease. This isn’t a “maybe someday” risk – it’s happening right now to real people in the prime of their lives.
But beyond these extreme cases, there’s something else that concerns me deeply as I think about our PAD community: how smoking directly undermines the most important therapy we have.
The PAD Walking Paradox: Why Smoking Sabotages Your Most Important Therapy
If you’ve been following my work for any length of time, you know how passionate I am about walking programs for PAD. It’s the cornerstone of PAD treatment that every vascular specialist prescribes, and for good reason – it WORKS.
Why Walking Is Medicine for PAD
When you have PAD, walking becomes both your greatest challenge and your most powerful medicine. Here’s why:
When you walk to the point of claudication (that cramping, aching pain), you’re actually creating a controlled oxygen deficit in your muscles. Your body responds to this stress by trying to solve the problem - it stimulates the growth of new blood vessels (collaterals) to bypass the blockages and deliver more oxygen.
These collateral vessels are your body’s natural bypasses. They’re like the detour roads your body builds around the blocked highways. Every time you push through that pain barrier in your walking program, you’re telling your body, “We need more routes for blood flow down here!”
Many of you know this isn’t easy. You’re literally walking through pain on purpose, day after day, sometimes for months. It takes incredible dedication. I’ve watched PAD Warriors in our community transform from barely making it down the driveway to walking a mile or more without stopping. It’s remarkable what the body can do when given the right signals.
How Smoking Destroys Your Walking Program’s Benefits
But here’s where smoking creates a devastating paradox – and this is really what keeps me up at night:
You’re putting in all this hard work, pushing through pain, forcing your body to build collaterals… while simultaneously smoking, which actively prevents and destroys those very same collaterals you’re working so hard to develop.
Remember that research I mentioned earlier? Smokers experience a 23% reduction in collateral vessel formation compared to non-smokers. Think about that - you’re doing everything right with your walking program, but if you’re smoking, nearly a quarter of the potential benefit is immediately erased.
Not only that, but smoking:
Makes it harder to walk in the first place - The carbon monoxide in smoke reduces oxygen in your bloodstream by up to 15%, making claudication pain come on faster and more severely.
Creates a hostile environment for new vessels - The endothelial damage from smoking makes it difficult for your body to form healthy new collateral vessels, no matter how consistently you walk.
Accelerates the blockage of existing collaterals - The same inflammatory and plaque-building processes that blocked your main arteries will attack those precious new collaterals too.
It’s like spending hours building a sandcastle while simultaneously pouring buckets of water on it. Your construction efforts can’t keep up with the destruction.
The Real-World Impact
I see this play out in our community every day. A dedicated PAD Warrior follows their walking program religiously for months. They’re making progress - walking farther, having less pain. But because they continue to smoke, that progress eventually stalls or reverses despite their diligent efforts.
Meanwhile, another patient with similar blockages quits smoking AND does their walking program. Within months, the difference is dramatic. Their collaterals flourish, their walking distance increases, and their claudication pain diminishes.
This stark contrast becomes even more pronounced when we factor in other conditions that so many of you are managing alongside PAD.
The Double Trouble: Smoking + Diabetes
Many of you in our community are managing both PAD and diabetes – a challenging combination by itself. But when I asked Dr. Khatib about this particular scenario, his warning was crystal clear: when you add smoking to diabetes, you create what he called “a very substantial issue” and a “much, much harder blockage to treat.”
Think about that for a second. If you’re struggling with diabetes and PAD, smoking isn’t just another risk factor – it’s like pouring gasoline on an already dangerous fire. The interventional specialists I talk to constantly tell me the same thing: treating smokers with diabetes who have PAD is exponentially more difficult than treating non-smokers.
But what exactly makes smoking so uniquely destructive? To understand that, we need to look at what’s actually in cigarette smoke.
What’s Actually IN Cigarette Smoke?
This was the part of my conversation with Dr. Khatib that truly horrified me. There are over 7,000 chemicals in tobacco smoke, including:
Formaldehyde (used to preserve dead bodies)
Cadmium (found in battery acid)
Benzene (a major cause of bladder cancer)
Arsenic (yes, actual rat poison)
And while we all know about nicotine, Dr. Khatib made an interesting point: as a cardiologist, nicotine worries him the least among all these chemicals. It’s all the other substances that do the real damage to your blood vessels.
Understanding what’s in cigarette smoke helps explain the comprehensive assault it launches on your arteries with every puff.
The Multi-Pronged Attack on Your Arteries
Imagine your arteries as a complex highway system designed to deliver life-giving oxygen throughout your body. Smoking isn’t just setting up a few toll booths on this highway – it’s launching a full-scale assault on the entire infrastructure.
Dr. Khatib broke down exactly how smoking wreaks havoc on our blood vessels, and each mechanism is more concerning than the last:
1. The Endothelial Ambush
Let me take a step back to explain how these smoking chemicals actually reach your arteries in the first place. Here’s the basic process: when you inhale cigarette smoke, your lungs absorb not just oxygen but also all those toxic chemicals. Your blood picks up this dangerous cocktail along with the oxygen in the tiny air sacs (alveoli) of your lungs.
This contaminated blood then returns to your heart, which pumps it out through your arteries to every tissue and organ in your body—including your legs. With every breath of cigarette smoke, you’re essentially injecting thousands of toxic chemicals directly into your bloodstream.
Now, your arteries are lined with a thin, smart layer called the endothelium. This isn’t just any old lining – it’s a sophisticated barrier that helps regulate blood flow, prevent clotting, and keep your arteries flexible.
When you smoke, you’re sending in a squad of toxic chemicals to damage this crucial layer. It’s like taking a perfectly orchestrated symphony and replacing the conductor with a chaotic toddler.
Dr. Khatib emphasized this point strongly. When the endothelial cells get damaged, it allows cholesterol and inflammatory cells to seep into the vessel wall, creating blockages. This damage, known as endothelial dysfunction, is the starting point for a cascade of vascular problems.
2. The Sticky Blood Situation
Once that endothelial barrier is compromised, smoking creates another problem that’s particularly devastating for PAD patients.
Picture this: You’ve just spent months following your walking program, gradually building those precious collateral vessels – the body’s natural bypasses around blockages. It’s like renovating your house with wider hallways, new doors, and extra rooms.
But then, smoking comes along and pours thick, sticky syrup all over your beautiful new floors.
Smoking makes your blood thicker, stickier, and more prone to clotting. Research published in the Journal of Vascular Surgery found that smokers had a 23% reduction in collateral vessel formation compared to non-smokers. It’s like your body is trying to build new roads, but smoking is constantly tearing them down.
This is particularly problematic for those new collateral vessels you’re working so hard to grow. These smaller blood vessels are like narrow hallways – the thick, sticky blood has a much harder time flowing through these smaller passages.
3. The Oxygen Theft
As if damaging your vessels and making your blood sticky weren’t enough, smoking also directly sabotages the main purpose of your circulatory system: delivering oxygen.
Your walking program is essentially a delivery service, working hard to bring oxygen to all parts of your body. But smoking? It’s the thief that’s stealing that precious oxygen before it can be delivered.
Smoking introduces carbon monoxide into your bloodstream, which binds to your red blood cells 200 times more readily than oxygen does. Studies in the American Journal of Physiology found that smokers had up to 15% less oxygen in their blood compared to non-smokers.
It’s like filling your car’s gas tank with water instead of fuel – you’re not going to get very far. No matter how diligently you follow your walking program, smoking is actively sabotaging your efforts by reducing the oxygen content of your blood.
4. The Inflammation Insurrection
The damage doesn’t stop there. One of the most important benefits of your walking program is reducing inflammation in your blood vessels. It’s like applying a soothing balm to your arteries. Smoking, on the other hand, is like throwing hot sauce on a sunburn.
As your endothelium takes a beating, your body’s alarm system activates. White blood cells rush to the scene, triggering inflammation. Research published in the journal Circulation found that smokers had significantly higher levels of inflammatory markers in their blood compared to non-smokers.
This ongoing inflammation makes your artery walls sticky, attracting more troublemakers like cholesterol and other fatty substances. These build up, forming plaques that further narrow your arteries – exactly what you’re trying to combat with your walking program.
5. The Plaque Parade and Collateral Collapse
The cumulative effect of all these mechanisms is a relentless progression of arterial damage. As these plaques grow, they start to narrow your arteries. Those wide-open highways we mentioned? They’re turning into clogged city streets during rush hour.
Dr. Khatib used some powerful illustrations that really helped me understand what’s happening inside our vessels when we smoke:
Imagine your artery as a hose with three layers. The innermost layer is extremely thin – just a single layer of cells called the intima. Its main job when healthy is to prevent anything from seeping inside the vessel wall and creating plaque.
When that layer gets damaged by smoking (or diabetes, or both), cholesterol starts seeping in, creating plaque. Eventually, a clot forms on top of the plaque, and the vessel becomes occluded.
Every step you take in your walking program is an attempt to grow new, smaller blood vessels to bypass these blockages. But smoking is actively working against you, making it harder for your body to form these new pathways. It’s like trying to build a detour while someone keeps tearing down your construction signs.
The Marijuana Misconception
Now, this is where conversations in our support groups often take an interesting turn. Someone inevitably asks: “But what about marijuana? Isn’t it natural and therefore safer?”
Well, poison ivy is natural too, but you wouldn’t want to smoke that.
Dr. Khatib was crystal clear on this point. He’s personally treated patients with Buerger’s disease who never smoked cigarettes but only smoked marijuana. When you smoke marijuana, you’re still burning plant material and inhaling smoke, which produces many of the same harmful compounds found in tobacco smoke:
Carbon monoxide that steals oxygen
More tar than tobacco, which can build up in your cardiovascular system
Particulate matter that irritates blood vessels
Free radicals that damage vessel linings
Marijuana also uniquely affects your cardiovascular system by:
Increasing heart rate for up to three hours after use
Causing blood pressure fluctuations
Potentially reducing blood flow to the heart
So whether it’s tobacco or marijuana, smoking works directly against your walking program’s goals. The moment you burn something and breathe in that smoke, you’re damaging your blood vessels.
The Vaping Question
Another question I frequently get from our community follows a similar line of thinking: “I’ve switched from cigarettes to vaping. Is that better for my PAD?”
This is where things get a bit more nuanced. Dr. Khatib explained that while we have over 100 years of data on smoking, we only have about 10 years of information on vaping. Based on current data, vaping MAY be less harmful than smoking (though certainly not harmless).
His approach with patients is practical: if you’re already a smoker and want to use vaping as a SHORT-TERM bridge to quitting entirely, that might be reasonable. But for someone who has never smoked, starting to vape would be introducing harm where there was none before.
The key point here is that neither marijuana smoking nor vaping offers a safe alternative for PAD patients. The goal should be complete cessation of all smoke and vapor inhalation.
After Revascularization: Why Quitting Becomes Even More Critical
For those of you who have already undergone a revascularization procedure, this next section is particularly important. I asked Dr. Khatib about something many vascular specialists have told me – that smoking after revascularization can be even more problematic than before.
His response was both straightforward and powerful: “Smoking is worse, period.”
He explained that if you’ve already had PAD severe enough to require revascularization, you’re “already at the tail end” of vascular damage. Even if your right leg has been successfully treated, your left leg (and your heart and brain vessels) probably already have 50%, 60%, or 70% blockages that might not need intervention yet – IF you quit smoking.
But if you continue to smoke after your procedure, those other blockages will continue to progress, potentially leading to contralateral leg amputation, heart attack, stroke, or even sudden death.
So if you’ve already had an intervention, the stakes for quitting are even higher. But here’s where I want to share some genuinely encouraging news.
The Reversal of Fortune: What Happens When You Quit
Despite all the doom and gloom I’ve shared about smoking’s effects, there’s a powerful silver lining: quitting smoking can rapidly reverse many of these negative effects. Here’s the timeline of healing:
Within 20 minutes: Your heart rate and blood pressure start to drop.
Within 12 hours: The carbon monoxide level in your blood drops to normal.
Within 2-12 weeks: Your circulation improves and your lung function increases.
Within 1 year: Your risk of heart disease is about half that of a smoker.
A study in the Journal of the American College of Cardiology found that former smokers who had quit for more than 10 years had a similar ability to grow new blood vessels as people who had never smoked. It’s never too late to quit!
Dr. Khatib emphasized that these harmful processes are “reversible to a large extent, or at least controllable.” At different intervals after quitting smoking, your risk for stroke, heart attack, amputation, heart failure, sudden death, and various cancers begins to decrease – in some cases returning almost to baseline after 10 years.
These remarkable improvements in vascular health are why we’ve created a comprehensive approach to help you quit.
Strategies for Quitting: Your Roadmap to Smoke-Free Success
I understand that knowing the dangers of smoking and actually quitting are two very different things. Quitting smoking isn’t easy – I’ve heard this from countless PAD Warriors – but it’s one of the most important steps you can take for your vascular health.
Based on what’s worked for members of our community and the latest research, here are some strategies that can help:
Nicotine Replacement Therapy: Patches, gum, or lozenges can help manage cravings.
Prescription Medications: Talk to your doctor about medications like Chantix or Zyban that can help you quit.
Behavioral Therapy: Working with a counselor can help you develop coping strategies for triggers.
Exercise: Your walking program can actually help! Exercise reduces cravings and withdrawal symptoms. When the urge to smoke hits, go for a short walk instead.
Support Groups: Connecting with others who are trying to quit provides motivation and practical tips.
Apps and Digital Tools: Try apps like QuitGuide or quitSTART that track your progress and savings.
Identify Triggers: Recognize situations that make you want to smoke and develop specific plans for each one.
All of these approaches are incorporated into our new smoking cessation program specifically designed for PAD patients. We’ve created it because the stakes for you are especially high, and the benefits of quitting are particularly profound.
The Bottom Line: Clear the Smoke to Clear Your Arteries
When you put together everything we’ve discussed today, the message becomes crystal clear: Living with PAD is challenging enough without sabotaging your own efforts by continuing to smoke.
Every cigarette you don’t smoke is a victory for your arteries. Quitting smoking is like removing all the toll booths from your blood vessel highways. Your walking program becomes significantly more effective when you’re not smoking. And it’s never too late to quit and start reversing the damage.
Think of it this way: if walking is your body’s construction crew, building new roads around the traffic jams, then smoking is the wrecking ball destroying their work faster than they can build.
My Personal Plea to You
This isn’t just medical information I’m sharing – it’s deeply personal for me. As the founder of the Global PAD Association, I’ve held the hands of too many PAD Warriors as they’ve faced amputations that might have been prevented if they’d quit smoking earlier. I’ve seen the tears, heard the regrets, and witnessed the life-altering consequences.
But I’ve also seen the incredible transformations that happen when people quit. I remember one gentleman in our support group who had been told he would need an amputation within months. He quit smoking cold turkey, followed his walking program religiously, and two years later, not only has he kept his leg, but he’s walking two miles a day without pain.
Your body WANTS to heal. It’s designed to repair itself. But it can’t do that when you’re constantly introducing thousands of toxic chemicals into your bloodstream with every cigarette.
We’re Here to Help You Succeed
I want you to know that the entire Global PAD Association community is here to support you on this journey. Quitting smoking might be the hardest thing you’ll ever do – but it’s also the most powerful step you can take to save your legs and extend your life.
Ready to take that step? Join our I QUIT smoking cessation program – a 12-week PAD-specific program designed to help you quit for good. Email Info@PADhelp.org to learn more and sign up.
Need immediate support? Call our leg saver hotline at 1-833-PAD-LEGS (1-833-723-5347) for more information on PAD, the risks of smoking on circulation, help with quitting, or to find a doctor who can help prevent amputation.
So take a deep breath (of fresh, smoke-free air) and know that by quitting smoking, you’re giving your arteries – and yourself – the best chance at a healthier future. Your future self, and your hard-working legs, will thank you for it!
You’ve got this, PAD Warriors. And we’ve got you!
Share this post