{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:23:07Z","timestamp":1793726587797,"version":"4.6.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005760","name":"University of Gothenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005760","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with diabetes are prone to peripheral angiopathy and neuropathy, predisposing them to diabetic foot ulcers and, ultimately, lower-extremity amputation. The long-term cardiovascular impact of amputation in persons with type 2 diabetes remains insufficiently characterised. The aim of this study was to examine the extent to which lower-extremity amputation in individuals with type 2 diabetes is associated with an increased risk of cardiovascular disease and mortality compared to those with type 2 diabetes without amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an observational, population-based retrospective cohort study with data from the Swedish National Diabetes Register linked to the National Patient Register and the Cause of Death Register. All individuals with type 2 diabetes who underwent a major or minor lower-extremity amputation between 2006 and 2019 were identified and matched to four controls with type 2 diabetes but without previous amputation on age, sex, and calendar time. Adjusted hazard ratios (aHRs) for cardiovascular events and mortality were estimated using cause-specific Cox proportional hazards regression, accounting for demographic and clinical risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3,485 individuals with type 2 diabetes who had undergone amputation and 13,940 matched controls without previous amputation were included. Individuals undergoing amputation had a markedly increased risk of cardiovascular disease and mortality, with aHRs (95% CI) of 2.46 (2.31\u20132.61) for all-cause mortality, 2.43 (2.18\u20132.71) for cardiovascular mortality, 2.13 (1.92\u20132.36) for heart failure, 1.79 (1.55\u20132.08) for myocardial infarction, and 1.52 (1.31\u20131.76) for stroke. The hazard of all-cause mortality was more than threefold higher in the first year after amputation compared with matched controls and remained about 50% higher after five years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower-extremity amputation in individuals with type 2 diabetes is associated with a substantially increased risk of cardiovascular disease and mortality, independent of pre-existing cardiovascular disease and established risk factors. This underlines the need for intensive cardiovascular risk management both before and after amputation to improve long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12933-026-03319-5","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:58:37Z","timestamp":1787587117000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Excess risk of cardiovascular disease and mortality after amputation in type 2 diabetes: a nationwide population study from the Swedish National Diabetes Register"],"prefix":"10.1186","volume":"25","author":[{"given":"Karin","family":"Bergqvist","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Imberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Hallstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Michelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Liljeb\u00e4ck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Franz\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Norhammar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Rosengren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Lind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"3319_CR1","doi-asserted-by":"crossref","unstructured":"Duncan BB, Magliano DJ, Boyko EJ. 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The study was approved by the Swedish Ethical Review Authority.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"KB has no competing interests to declare. HI has no conflict of interest. SH has lectured for Novo Nordisk. JM has no conflict of interest. HL has no conflict of interest. SF is an employee of AstraZeneca and holds shares in AstraZeneca. AR has no competing interest to declare. AN has been consultant and received honoraria from AstraZeneca, Novo Nordisk, MSD and Boehringer Ingelheim. ML has received research grants from Eli Lilly and Novo Nordisk and been consultant or received honoraria from Boehringer Ingelheim, Eli Lilly, Nordic Infucare, Novo Nordisk and Rubin Medical, all outside the submitted work.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"260"}}