To investigate the risk factors for lower extremity atherosclerosis disease (LEAD) in the elderly people. Methods Included as case group were 98 elderly LEAD patients treated in the Vascular Surgery of People′s Hospital in Inner Mongolia Autonomous Region and the Vascular Surgery of Peking Union Medical College Hospital from May 1,3 to December 31,4. At the same time, 70 healthy elderly people were enrolled as the control group who received check-ups at the 2 institutions. The baseline data and clinical indices of the 2 groups were collected and compared. SPSS statistics 19.0 was used for statistical analysis, and independent samples t test or χ² test, depending on data type, was used for comparison. The independent variables with P<0.01 in univariate analysis were included in a multiple logistic regression model to investigate the risk factors for LEAD in the elderly patients. Results The proportion of the male patients, the proportion of the smokers, hypertension rate, and systolic pressure in the case group were significantly higher than those in the control group, but diastolic pressure and body mass index were significantly lower (P<0.05). Of the clinical indices, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), insulin, creatinine and high sensitivity C-reactive protein (hs-CRP) were significantly higher in the case group than in the control group, but the high-density lipoprotein cholesterol (HDL-C) and ankle brachial index (ABI) were significantly lower (P<0.05). Multiple factor logistic regression showed that sex (OR=1.007,5%CI 0.201-1.232), smoking (OR=0.181,5%CI 0.044-1.119), systolic pressure (OR=0.153, 95%CI 0.135-0.198), FBG (OR=3.226,5%CI 1.589-5.103), HOMA-IR(OR=2.971,5%CI 1.456-4.716), insulin(OR=1.996,5%CI 1.309-3.311), HDL-C(OR=0.311, 95%CI -0.237-0.515), hs-CRP(OR=1.058,5%CI 0.313-1.157)and ABI(OR=-3.011, 95%CI -4.238--2.010)were independent risk factors for LEAD (P<0.05). Conclusion Screening for LEAD should be emphasized in the elderly men with hypertension or diabetes, and they should be advised to quit smoking, control blood pressure and glucose, and reduce lipid.