The association of hyperlipidemia or cigarette smoking and ischemic heart disease has been studied for many years. Several recent reports have related these factors to peripheral atherosclerosis; however, most included patients having peripheral and coronary arterial lesions. We have studied 349 patients with atherosclerosis, separating them into groups defined by types and locations of lesions, comparing them with each other and with a control group not having symptoms or findings of atherosclerosis. Each patient underwent lipid analysis and had a careful smoking history taken. Several differences were noted between the groups, and increasingly severe lipid abnormalities or smoking exposures were found associated with greater dissemination of obliterative atherosclerotic lesions.