African-Americans who smoke cigarettes are more likely than those who don’t smoke to develop peripheral artery disease, a U.S. study suggests, according to Reuters.

Smoking has long been linked to increased risk for peripheral artery disease (PAD), which restricts blood flow to the extremities and can lead to mobility limitations, amputations and heart attacks. Even though African-Americans are almost three times more likely to develop PAD than white people in the U.S., research to date hasn’t offered a clear picture of what role smoking plays in the development of this artery disease in the black community.

For the current study, researchers examined data on 5,306 black men and women enrolled in the Jackson Heart Study in Mississippi to see how any current or past smoking might influence their risk of having early, symptomless indications of PAD in the extremities and in the aorta, the body’s main artery.

At the start of the study, 68 percent of the participants had never smoked, while 19 percent were former smokers and 13 percent were current smokers.

Compared to nonsmokers, current smokers were more than twice as likely to have signs of “subclinical,” or symptomless, PAD in their extremities, such as reduced blood flow in the ankles. Current smokers were also more than nine times as likely to have calcification, a sign of subclinical PAD, in their aorta, researchers report in the Journal of the American Heart Association.

“Among African Americans, cigarette smoking is highly associated with measures of a PAD, and individuals who smoke more appear to have worse disease,” said lead study author Dr. Donald Clark III of the University of Mississippi Medical Center in Jackson.

“In addition to the often cited risks of cardiovascular disease and cancer, in this population there is a clear association with smoking and PAD,” Clark said by email. “These data support efforts evaluating the impact of interventions on smoking cessation to reduce PAD in this population.”

Peripheral artery disease (PAD) is a narrowing of arteries other than those directly serving the heart. These blood vessels provide blood flow to the arms, legs, the brain and other organs such as the kidneys.