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The interaction of genetic predisposition, harmful compounds released in cigarette smoke, metabolism of toxins, and intersection with concomitant risk factors influence the individual PAD expression ( Figure 1 The pathophysiology of PAD is complex and multifactorial and involves a variety of cells including endothelial cells, inflammatory cells, vascular smooth muscle cells, and platelets ( Multiple components of cigarette smoke are potentially harmful compounds

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This makes it harder for blood to flow, and also increases blood pressure and heart rate