Cardiovascular disease is the leading cause of mortality and morbidity among people with diabetes mellitus. The epidemic of diabetes continues to contribute significantly to the global burden of cardiovascular disease with varying epidemiological trends in different regions and resource settings. Understanding and estimating cardiovascular risk is an essential component of diabetes care. Increasingly, assessment of absolute cardiovascular risk in individuals with diabetes is used to guide treatment targets and medical therapies. Numerous approaches to assessing cardiovascular risk in diabetes have been developed. These largely rely on traditional risk factor associations, but there is substantial ongoing research into novel biomarkers and genetics. This chapter provides an overview of cardiovascular risk in diabetes, including epidemiology, mechanisms and a particular focus on risk prediction.