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A widely cited Finnish study published in 1998 found that people with diabetes and no history of myocardial infarction had as high a risk of myocardial infarction as people with a history of prior myocardial infarction but not diabetes (7-year incidences of 20.2 and 18.8% respectively) [22]. The view that diabetes is a risk equivalent to established coronary vascular disease for incident cardiac events is still often espoused today [10]. However, it is probably not true in most populations. A meta-analysis of 13 studies involving more than 45,000 patients found the risk of myocardial infarction was 43% lower in patients with diabetes but no personal history of coronary disease compared to patients without diabetes but with prior myocardial infarction [23]. A contemporary study from a membership-based health service in the United States, conducted using electronic medical record data from over 1.5 million adults, also found existing coronary disease to be associated with a higher incidence of myocardial infarction than diabetes alone (22.5 vs. 12.2 events per 1,000 person-years) [24]. Knowing whether or not diabetes is a risk equivalent to known coronary disease is relevant in guiding the approach to management of cardiovascular risk factors in patients with diabetes. If diabetes is a risk equivalent, perhaps intensive therapy, as used in secondary prevention of ischaemic heart disease, should be adopted routinely for all patients with diabetes. On the contrary, perhaps the clinical approach should vary depending on a more nuanced assessment of an individual patient’s risk, with more intensive intervention reserved for those at higher personal risk.