A prospective, case-control study of tobacco dependence in thromboangiitis obliterans (Buerger's disease)

Thromboangiitis obliterans (TAO) is often cited as an extreme phenotype of vasculopathy and tobacco dependence. Although tobacco exposure is essential to progression of arterial ischemia in TAO, expert opinion differs regarding the degree of tobacco dependence in this population. The authors designed a prospective, case-control study to test the hypothesis that subjects with TAO have a greater degree of tobacco dependence than control subjects with coronary atherosclerosis (coronary artery disease [CAD]) do. Subjects with TAO (n = 218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n = 343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding tobacco use, to which 103 and 273 responded, respectively. The degree of tobacco dependence in each group was ascertained by several methods, including the Fagerström Test for Nicotine Dependence Questionnaire. The TAO group was younger at index date (year of first diagnosis for TAO patients, year of percutaneous transluminal coronary angioplasty [PTCA] for CAD patients) (TAO 37.6 ± 9.0 vs CAD 43.3 ± 4.9 yr, p < 0.0001), but the groups did not differ in age at first tobacco exposure (TAO 16.7 ± 3.1 vs CAD 17.3 ± 4.2 yr, p = 0.67), current tobacco use at time of survey (TAO 54% vs CAD 46%, p = 0.17), or Fagerström score (TAO 4.7 ± 2.3 vs CAD 5.1 ± 2.3, p = 0.24). Kaplan-Meier curves showed no significant difference in time to stopping tobacco use after first diagnosis (p = 0.076). TAO subjects smoked fewer cigarettes per day than CAD subjects (TAO 22.3 ± 10.7 vs CAD 27.7 ± 15.3 cigarettes/day, p = 0.003). Among current smokers (n = 170), TAO subjects also smoked fewer cigarettes/day (20.2 ± 8.2 vs 24.6 ± 12.7, p = 0.03), and were more likely to have made a serious attempt to stop (97% vs 90%, p = 0.03). In contrast to case reports of extreme tobacco dependence in the TAO population, the degree of tobacco dependence in subjects with TAO is similar to that in subjects with CAD.