{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:43:37Z","timestamp":1790808217279,"version":"4.1.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"GeorgeThink"},{"name":"National Institute for Health and Care Research (NIHR) Doctoral Fellowship","award":["NIHR301767"],"award-info":[{"award-number":["NIHR301767"]}]},{"name":"NSW Cardiovascular Elite Postdoctoral Researcher Grant","award":["H23\/15813"],"award-info":[{"award-number":["H23\/15813"]}]},{"name":"Australian NHMRC Investigator Grant, Leadership 2","award":["APP1174120"],"award-info":[{"award-number":["APP1174120"]}]},{"name":"Australian NHMRC Program Grant","award":["APP1149987"],"award-info":[{"award-number":["APP1149987"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To investigate whether the relationship between smoking and peripheral artery disease (PAD) differs by sex (PROSPERO CRD42022352318).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      PubMed, EMBASE, and CINAHL were searched (3 March 2024) for studies reporting associations between smoking and PAD in both sexes, at least adjusted for age. Data were pooled using random effects. Between-study heterogeneity was examined using I\n                      <jats:sup>2<\/jats:sup>\n                      statistic and Cochran\u2019s Q test. Newcastle-Ottowa Scale was adopted for quality assessment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four cohort studies (n = 2,117,860, 54.4% women) and thirteen cross-sectional studies (n = 230,436, 59.9% women) were included. In cohort studies, former and current smokers had higher risk of PAD than never smokers. Compared to those who never or previously smoked, women current smokers (relative risk (RR) 5.30 (95% confidence interval 3.17, 8.87)) had higher excess risk of PAD than men (RR 3.30 (2.46, 4.42)), women-to-men ratio of RR 1.45 (1.30, 1.62)(I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.328). In cross-sectional studies, risk of PAD was higher among former and current compared to never smokers, more so in men, women-to-men ratios of odds ratio: 0.64 (0.46, 0.90)(I\n                      <jats:sup>2<\/jats:sup>\n                      = 30%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.192), 0.63 (0.50, 0.79)(I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.594), respectively. For both sexes, risk of PAD was higher among current smokers compared to those who were not currently smoking. Cohort studies and five cross-sectional studies were of good quality, scoring 6 to 8 of a possible maximum 9 points. Eight cross-sectional studies scored 2 to 5.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussions<\/jats:title>\n                    <jats:p>Further research is required to elucidate sex differences in the relationships between smoking and PAD, as the current evidence is limited and mixed. Tobacco-control programs should consider both sexes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0300963","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T13:22:01Z","timestamp":1713964921000},"page":"e0300963","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Smoking as a risk factor for lower extremity peripheral artery disease in women compared to men: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3793-7716","authenticated-orcid":true,"given":"Ying","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2329-6193","authenticated-orcid":true,"given":"Anna Louise","family":"Pouncey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6543-7113","authenticated-orcid":true,"given":"Zien","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-5296","authenticated-orcid":true,"given":"Mark","family":"Woodward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"issue":"8","key":"pone.0300963.ref001","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s11883-018-0742-x","article-title":"Peripheral arterial disease in women: an overview of risk factor profile, clinical features, and outcomes.","volume":"20","author":"Q-u-a Jelani","year":"2018","journal-title":"Current Atherosclerosis Reports"},{"issue":"5","key":"pone.0300963.ref002","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1136\/heartjnl-2013-304082","article-title":"Meta-analysis of the association between cigarette smoking and peripheral arterial disease","volume":"100","author":"L Lu","year":"2014","journal-title":"Heart"},{"issue":"9799","key":"pone.0300963.ref003","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/S0140-6736(11)60781-2","article-title":"Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies","volume":"378","author":"RR Huxley","year":"2011","journal-title":"Lancet"},{"issue":"11","key":"pone.0300963.ref004","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1016\/j.jacc.2016.11.007","article-title":"2016 AHA\/ACC guideline on the management of patients with lower extremity peripheral artery disease","volume":"69","author":"MD Gerhard-Herman","year":"2017","journal-title":"J Am Coll Cardiol"},{"issue":"10292","key":"pone.0300963.ref005","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"MB Reitsma","year":"2021","journal-title":"The Lancet"},{"issue":"12","key":"pone.0300963.ref006","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/0895-4356(91)90101-E","article-title":"Smoking characteristics and inhalation biochemistry in the Scottish population","volume":"44","author":"M Woodward","year":"1991","journal-title":"J Clin Epidemiol"},{"key":"pone.0300963.ref007","article-title":"The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses","author":"G Wells","year":"2000"},{"issue":"27","key":"pone.0300963.ref008","doi-asserted-by":"crossref","first-page":"iii-x, 1","DOI":"10.3310\/hta7270","article-title":"Evaluating non-randomised intervention studies.","volume":"7","author":"JJ Deeks","year":"2003","journal-title":"Health Technol Assess"},{"issue":"1","key":"pone.0300963.ref009","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/1471-2458-13-154","article-title":"Are healthcare workers\u2019 intentions to vaccinate related to their knowledge, beliefs and attitudes? 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