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TOPLINE
Patients with type 2 diabetes (T2D) who underwent lower-extremity amputation faced more than double the risk for all-cause and cardiovascular death compared with those who did not undergo amputation. The excess risk was steepest during the first year after amputation but remained elevated for at least a decade.
METHODOLOGY
- Researchers in Sweden conducted a retrospective cohort study using data from linked national registers to assess the excess risk for cardiovascular disease and death associated with lower-extremity amputation in patients with T2D.
- They analysed 3485 patients (mean age, 74 years; 35% women) with T2D who underwent a major (above the ankle) or minor (below the ankle) lower-extremity amputation between 2006 and 2019 and 13,940 matched control participants with T2D but no prior amputation.
- All participants were free of prior myocardial infarction, hospitalisation for heart failure, and stroke at cohort entry.
- Outcomes included all-cause and cardiovascular death, myocardial infarction, heart failure, and stroke.
- The median follow-up duration was 3.5 years.
TAKEAWAY
- Patients with T2D who underwent lower-extremity amputation had a 2.46-fold higher risk for all-cause mortality than control participants (adjusted hazard ratio [aHR], 2.46; P < .001) after adjustment for established risk factors including blood pressure, A1c and cholesterol levels, smoking, and BMI.
- The risk for cardiovascular death was significantly elevated (aHR, 2.43), as were risks for heart failure (aHR, 2.13), myocardial infarction (aHR, 1.79), and stroke (aHR, 1.52; P < .001 for all).
- In a separate analysis, modelled estimates showed that the excess risk for all-cause death was greatest during the first year after amputation (aHR, 3.30; 95% CI, 3.04-3.58) and remained significantly elevated at 10 years (aHR, 1.80; 95% CI, 1.27-2.56).
- Major amputation carried a higher risk for all-cause death than minor amputation (aHR, 2.78 vs 1.90).
IN PRACTICE
"[The study] findings underscore the importance of optimised cardiovascular and metabolic risk management both before and after amputation, including strict glycaemic control, vascular protection, renal support, and close clinical monitoring to reduce complications and improve patient outcomes," the authors wrote.
SOURCE
The study was led by Karin Bergqvist, University of Gothenburg, Gothenburg, Sweden. It was published online on August 24, 2026, in Cardiovascular Diabetology.
LIMITATIONS
Because the study relied on registry data, it was vulnerable to missing information and residual confounding. The study period partly predated the widespread use of GLP‑1 receptor agonists and SGLT2 inhibitors, which could have altered outcome patterns. Finally, participants were free of previously diagnosed severe cardiovascular disease; therefore, the findings may not generalise to the broader population undergoing amputation.
DISCLOSURES
This study was funded by Swedish governmental funding of clinical research, the Swedish Research Council, and the Swedish Heart Lung Foundation. One author disclosed being an employee and shareholder of AstraZeneca. Several authors reported receiving consulting fees, honoraria, or research grants from various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
