Smokers with symptomatic atherosclerotic disease have a sevenfold increased risk of amputations and other major adverse limb events, a Dutch study shows.

Systolic blood pressure and non-HDL cholesterol were also linked to an elevated risk of such events, highlighting the importance of risk factor management in patients with vascular disease, say the researchers, led by the University Medical Center, Utrecht.

The team analysed data from more than 8000 patients (mean age 60) to determine the effect of systolic blood pressure, cholesterol concentrations and smoking status on the risk of major adverse limb events — which included amputations, thrombolysis or revascularisations — and major adverse cardiovascular events.

Almost two-thirds of participants had a history of coronary artery disease, 30% with CVD, 18% had peripheral artery disease and 9% had abdominal aortic aneurysm.