Cardiovascular disease is the major cause of morbidity and mortality in both men and women with diabetes (approximately 60-70% of deaths). The risk of cardiovascular disease is increased approximately 2 fold in men and 3-4 fold in women. In the Framingham study, the annual rate of cardiovascular disease was similar in men and women, emphasizing that woman with diabetes need as aggressive preventive treatment as men with diabetes. In addition, several studies have shown that patients with diabetes who have no history of cardiovascular disease have the same risk of having a myocardial infarction as non-diabetics who have a history of cardiovascular disease, i.e., diabetes is an equivalent risk factor as a history of a previous cardiovascular event. Moreover, numerous studies have shown that patients with diabetes who have cardiovascular disease are at a very high risk of having another event, indicating that this population of patient’s needs especially aggressive preventive measures. This increased risk for the development of cardiovascular disease in patients with diabetes is seen in populations where the prevalence of cardiovascular disease is high (Western societies) and low (for example, Japan). It should be noted though, that in populations where cardiovascular disease is less frequent, the impact of diabetic related cardiovascular disease on mortality is more modest, indicating the importance of other risk factors in modulating the impact of diabetes (see below). Importantly, while mortality from cardiovascular disease in the U.S. is decreasing in the non diabetic population, mortality from cardiovascular disease is not declining in patients with diabetes pointing out the need to target this population for aggressive preventive measures. While the database is not as robust, the evidence indicates that patients with Type 1 diabetes are also at high risk for the development of cardiovascular disease. Lastly, in patients with both Type 1 and Type 2 diabetes the presence of renal disease increases the risk of cardiovascular disease.