The association of diabetes and cardiovascular disease is a major health concern in the elderly population. Patients 65 years of age or older with diabetes have a greater risk of ischemic heart disease and cardiovascular mortality than nondiabetic patients of the same age. In addition, although there has been an overall reduction in cardiovascular disease morbidity and mortality in the United States over the past 50 years, the burden of cardiovascular disease attributable to diabetes mellitus has actually increased over this time. In addition to traditional risk factors (eg, hypertension, dyslipidemia), the effect of nonclassical cardiovascular risk factors, such as exogenous and endogenous insulin, metabolic syndrome, impaired fasting glucose, chronic kidney disease, advanced glycation end products, and adipokines, in elder patients with diabetes is currently being evaluated. This article addresses current evidence related to cardiovascular risk in elderly patients with diabetes.